[High-risk congenital diaphragmatic aplasia and hernia (apropos of 64 cases)].
The prognosis of high risk congenital diaphragmatic hernia and eventration diagnosed in the early neonatal period (before 24 h) is studied based on a series of 64 cases. Eventration has a poor prognosis with 5 deaths out of 7 cases. The replacement of the hemidiaphragm by an abdominal muscular flap seems to be the best surgical procedure (2 recoveries on 4 cases). A high mortality rate remains in the diaphragmatic hernias which are undiagnosed before birth. Out of 54 operated cases with systematic homolateral drainage, there were 35 survivors (65%). Post-operative alveolar-arterial PO2 difference less than 53 kPa appears to be a reliable criterion of good prognosis with a survival rate of 91% in this series. Thus, despite major progresses in post-operative resuscitation, the recovery rate in high risk neonatal congenital diaphragmatic hernia and eventration is only 75%. This seems to be partly related to the existence of lethal forms due to bilateral pulmonary hypoplasia and structural anomalies of the pulmonary arteries.
Service de Pathologie et de Réanimation néo-natale, Hôpital Debrousse, Lyon, France.
J
J
Bourgeois
F
F
Philip
J C
JC
Berthier
D
D
Louis
G
G
Axiotis
T
T
Basset
M
M
Bethenod
D001784:Blood Gas Analysis; D003965:Diaphragmatic Eventration / Q000601:surgery*; D006548:Hernia, Diaphragmatic / Q000097:blood / Q000601:surgery*; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D007231:Infant, Newborn; D011184:Postoperative Period; D011379:Prognosis; D012151:Resuscitation; D012307:Risk Factors
Aplasie et hernie diaphragmatiques congénitales à haut risque (à propos de 64 observations).