title: Acute gastrointestinal compromise in neonates with congenital diaphragmatic hernia prior to repair.
abstract: BACKGROUND
  Congenital diaphragmatic hernia (CDH) affects 1 in 3000 live births. Modern management strategies include delayed repair of the diaphragm to permit pre-operative optimization of cardiorespiratory status. We describe a cohort of neonates in whom early emergency operative intervention was required for potentially fatal intestinal compromise.
  
  
  METHODS
  A retrospective review was performed of all neonatal CDH patients managed at a tertiary center in an 8-year period (2005-2012).
  
  
  RESULTS
  A total of 126 CDH patients were managed during the 8-year period. Five neonates (male - 1; gestation 37+4-39+7; birth weight 2.9-3.7kg; left CDH - 5) required emergency operative intervention for presumed gastrointestinal compromise. All five neonates demonstrated systemic hypotension despite inotropic support, raised serum lactate (>2mmol/L), and abnormal radiographic findings. Operative intervention occurred within 3days of birth (1-3days). Findings included gastric volvulus, jejunal volvulus, and perforated caecum. All patients underwent primary diaphragmatic repair without a patch. Temporary ileostomy was required in 1 patient. All patients remain alive.
  
  
  CONCLUSIONS
  Gastrointestinal compromise is a rare, but potentially catastrophic, complication of CDH. Emergency operative intervention may be required in a select cohort of patients. Early deterioration following birth should alert clinicians to the possibility of significant intestinal pathology.
  
  
  METHODS
  Level IV case series with no comparison group.
authors.affiliation: Paediatric Infant Perinatal Emergency Retrieval Service, The Royal Children's Hospital, Melbourne, Victoria, Australia. Electronic address: catherine.fox@rch.org.au.
authors.forename: Catherine
authors.initials: C
authors.lastname: Fox
authors.affiliation: Paediatric Infant Perinatal Emergency Retrieval Service, The Royal Children's Hospital, Melbourne, Victoria, Australia; Department of Neonatal Medicine, The Royal Children's Hospital, Melbourne, Victoria, Australia; Department of Neonatal Services, The Royal Women's Hospital, Melbourne, Victoria, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Stewart
authors.affiliation: Department of Paediatric Surgery, The Royal Children's Hospital, Melbourne, Victoria, Australia; Surgical Research Department, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Sebastian K
authors.initials: SK
authors.lastname: King
authors.affiliation: Department of Neonatology, Royal Hospital for Children, Glasgow, United Kingdom.
authors.forename: Neil
authors.initials: N
authors.lastname: Patel
mesh_terms: D002429:Cecal Diseases / Q000209:etiology / Q000601:surgery*; D005260:Female; D065630:Hernias, Diaphragmatic, Congenital / Q000150:complications / Q000601:surgery*; D006801:Humans; D007022:Hypotension / Q000209:etiology; D007231:Infant, Newborn; D007416:Intestinal Perforation / Q000209:etiology / Q000601:surgery*; D045822:Intestinal Volvulus / Q000209:etiology / Q000601:surgery*; D007579:Jejunal Diseases / Q000209:etiology / Q000601:surgery*; D008297:Male; D012189:Retrospective Studies; D013277:Stomach Volvulus / Q000209:etiology / Q000601:surgery
keywords: Acute gastrointestinal compromise; Congenital diaphragmatic hernia; Lactic acidosis; Neonatal; Neonatal surgery; Volvulus