Congenital diaphragmatic hernia is not a surgical emergency…. Instead of jumping to surgical treatment right away…we should treat the condition of the lung which is suffering from persistent pulmonary hypertension…(pph)
What is pph?
And so..ive just known the fact that there is such thing called the normal pulmonary hypertension which occur in utero… And normally after birth… The pressure in the pulmonary vasculature decreases. But this doesnt happen here…
The lung has been suffering since in utero due to the CDH, which cause hypoplasia and some states that there is abnormal pulmonary vasculature.
So whats the problem with this pph?
First..since the lungs are hypoplastic and suffering from pph, the baby after birth wont get as much oxygen required by the body…. Which is normally needed to cause closure of ductus arteriosus… And so…. What happens is… It will be patent(PDA)
Usually..in baby with NO CDH, pda causes a left to right shunt…but the reverse happens here because of PPH.hence..the cyanosis…
Once you start supplying the baby with oxygen through a face mask or nasal cannula..the condition will worsen. Why? The part of the intestine which is intrathoracic …will become distended with air..further compromising the lungs expansion.
So…first things first….. Do resuscitation…please do nasogastric decompression!!!
And then, you can do surgery
Another question…do you know whats eventration of the diaphragm?? It is when the muscular fibres of the diaphragm is replaced by fibroelastic tissue.this part of the diaphragm may cause compression of the lungs.
So..you have to treat the pph, and also the pda…before you do surgery ok???