[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.
Bourgeois
J
J
Service de Pathologie et de Réanimation néo-natale, Hôpital Debrousse, Lyon, France.
Philip
F
F
Berthier
J C
JC
Louis
D
D
Axiotis
G
G
Basset
T
T
Bethenod
M
M
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).