Neonatal Surgery
Congenital Diaphragmatic Hernia

 

Reviewed by Charge Nurse - Newborn
and Carl Kuschel
January
2005
Preoperative Care Postoperative Care Index of Related Documents

This is a congenital defect of the diaphragm with incomplete closure of the pleuroperitoneal membrane.  The abdominal viscera are displaced into the chest, and there is often concurrent pulmonary hypoplasia and significant persistent pulmonary hypertension of the newborn.  An echocardiogram is usually performed prior to surgery to exclude significant congenital cardiac disease and to assess the degree of pulmonary hypertension.

In general, these infants will be transferred to PICU as soon as practicable and receive their preoperative and postoperative care there.  On rare occasions, they may be looked after in NICU.

Preoperative Care of Infants with Congenital Diaphragmatic Hernia

Follow the steps below to ensure safety of baby is maintained pre-operatively.

Step

Action

1 Follow standard steps for preoperative care.
2 NO BAGGING VIA MASK.
3 Ventilation is maintained as per instructions.  Inhaled NO and HFOV may be required.
4 Medication for sedation and muscle relaxation is given as prescribed to maximise oxygenation.
5 The infant is nursed with the unaffected side slightly elevated to allow maximum chest expansion.
6 Monitor temperature closely. Hypothermia can lead to pulmonary vasoconstriction and pulmonary hypertension.
7 Close monitoring of pre- and post-ductal SaO2. This will indicate if significant ductal shunting is occurring.
8 Ensure that the large bore orogastric tube remains in-situ on free drainage with regular aspiration.
9 The baby remains nil by mouth.

Postoperative Care of Infants with Congenital Diaphragmatic Hernia

Follow standard steps for postoperative care and the chest drain protocol.


If you cannot see an index above, please press the "Refresh" button of your browser.