Current and emerging treatment for congenital diaphragmatic hernia

Hypoxia in the term newborn: part two-primary pulmonary disease, obstruction, and extrinsic compression

Pediatric care providers are repeatedly called upon to evaluate a cyanotic newborn in the labor and delivery suite, or in the well-baby nursery. A myriad of disorders spanning all-organ systems exist as possibilities for each of these problems, although several causes for newborn cyanosis are particularly common. In this second of a three-part series, primary pulmonary disease, airway obstruction, and extrinsic compression of the lungs as causes for newborn hypoxia are explored. It is in this group of disorders that we find the answers for the greatest number of these cyanotic dilemmas. Knowledge of the breadth of diagnoses, and respect for the variety of clinical possibilities, is the first step in providing a patient with accurate diagnosis, treatment, and referral.

The CDH Study Group and advances in the clinical care of the patient with congenital diaphragmatic hernia

Congenital diaphragmatic hernia (CDH) occurs in 1 of every 2000 to 4000 births and accounts for 8% of all major congenital anomalies. Recurrence risk for a subsequent pregnancy is estimated at 2%. The mortality rate for CDH when diagnosed antenatally, varies with fetal age and with the presence or absence of hydramnios and degree of pulmonary hypoplasia. The prognosis has improved dramatically in recent years, primarily due to advances in neonatal and surgical interventions. Neonatal survival rates with an antenatal diagnosis now exceed 80% in some centers. Treatment for infants with CDH reflects other pediatric surgical problems in that a majority of the clinical research that shapes treatment is retrospective in nature. Because CDH is a relatively rare disease, using a compilation of cases, such as the CDH database provides, greatly aids our understanding of this disease process. Moreover, the application of a quality assessment scale provides the practitioner with a knowledge base to critically evaluate the published retrospective data.

Neonatal surgical emergencies: stabilization and management

The transitional period following birth can be complicated by the presence of congenital anomalies requiring emergent surgical management. Newborns with congenital diaphragmatic hernia require immediate intubation and gastric decompression to minimize gastric distention, as well as cautious ventilation to avoid pneumothorax. Newborns with omphalocele and gastroschisis are at risk for bacterial contamination, as well as heat and evaporative losses from exposed viscera. These newborns benefit from the use of a protective bowel bag. Newborns with meningomyelocele require meticulous care to avoid infection and trauma to exposed portions of the spinal cord. An illustrated protocol provides guidance in the initial stabilization of these defects. Nurses providing family-centered care must be knowledgeable about congenital anomalies presenting at birth so they can properly stabilize these newborns and provide accurate information to families.