Abstract
In spite of advances in neonatal surgery, the mortality rate from diaphragmatic hernia (DH) remains high. Infants with the early onset of symptoms are at greatest risk and die of hypoxia in spite of successful repair of the defect. The objective of this study was to determine the incidence and to identify factors leading to hypoxemia and death in these infants. Of 21 infants born with DH in our hospital during the last 7 years, 13 had respiratory distress from birth. Nine (70%) of these 13 infants had persistent fetal circulation (PFC) which terminated in death in 6 (46%) infants. PFC was characterized by elevated right atrial pressure, hypoxemia in the descending aorta in spite of inhalation of 100% oxygen and evidence for right-to-left shunt at atrial or ductal levels. In patients who died, progressive hypoxemia and metabolic acidosis were accompanied by severe peripheral vasoconstriction, poor skin perfusion and systemic hypertension. In this study, PFC was the major cause of death in infants with DH. PFC occurred commonly and exclusively in infants whose symptoms were present at birth. Unless PFC is recognized early and reversed by vigorous treatment, the infants will die as a result of progressive hypoxemia and metabolic acidosis.
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Siassi, B., Cabal, L., Goldberg, R. et al. 1228 PERSISTENT FETAL CIRCULATION IN NEONATES WITH DIAPHRAGMATIC HERNIA. Pediatr Res 12 (Suppl 4), 568 (1978). https://doi.org/10.1203/00006450-197804001-01234
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DOI: https://doi.org/10.1203/00006450-197804001-01234