Changes and management in perioperative circulatory function in neonates with congenital diaphragmatic hernia
10.3760/cma.j.cn113903-20231107-00306
- VernacularTitle:先天性膈疝患儿生后围手术期循环功能的变化和管理
- Author:
Wei ZHANG
1
;
Lishuang MA
1
;
Ying WANG
1
;
Chao LIU
1
;
Tao WU
1
;
Yandong WEI
1
;
Jingna LI
1
;
Yanxia ZHANG
1
;
Yetong WANG
1
Author Information
1. 首都儿科研究所附属儿童医院新生儿外科，北京 100020
- Publication Type:Journal Article
- Keywords:
Hernias, diaphragmatic, congenital;
Left ventricular ejection fraction;
Pulmonary hypertension;
Treprostinil;
Urine output
- From:
Chinese Journal of Perinatal Medicine
2024;27(12):986-992
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To analyze the changes and management in perioperative circulatory function in neonates with congenital diaphragmatic hernia (CDH).Methods:A retrospective analysis was conducted on 52 cases of CDH children who were prenatally consulted and postnatally intubated and transported to the Neonatal Surgery Department of Children's Hospital, Capital Institute of Pediatrics from May 2021 to May 2023. The cases were divided into a survival group (42 cases) and a death group (10 cases) based on perioperative mortality. General data, left ventricular ejection fraction (LVEF) and pulmonary hypertension (PH) grading at different times (on the day of birth and seven days post-birth), as well as vasoactive inotropic score (VIS), treprostinil dosage, and urine output within 48 h post-surgery, were analyzed. Statistical analyses were performed using independent sample t-tests, rank-sum tests, Chi-square tests (or Fisher's exact test), or Wilcoxon non-parametric rank-sum tests. Results:(1) The gestational age at the first detection of CDH in the death group was earlier than that in the survival group [(22.9±3.0) weeks vs. (26.3±4.7) weeks, t=－2.17], and the proportion of liver herniation was higher in the death group [6/10 vs. 14% (6/42), χ2=10.56] (both P<0.05). In the death group, six cases underwent surgery, while four cases had unstable vital signs and no surgical opportunity. The proportion of open surgery and the use of patches were higher in the death group than in the survival group [4/6 vs. 14% (6/42); 4/6 vs. 9% (4/42); Fisher's exact test, both P<0.05]. (2) Among the operated cases in the death group, the VIS and treprostinil dosage within 48 h post-surgery were higher than those in the survival group {22.5 points (13.0-36.6 points) vs. 13.0 points (11.5-26.3 points), Z=－2.54; 19.5 ng/(kg·min) [8.0-22.5 ng/(kg·min)] vs. 9.0 ng/(kg·min) [4.8-20.0 ng/(kg·min)], Z=－2.52}; and the urine output was less than that in the survival group {1.4 ml/(kg·h) [0.7-2.0 ml/(kg·h)] vs. 3.0 ml/(kg·h) [2.8-3.7 ml/(kg·h)], Z=－2.61, all P<0.05)}. The LVEF on the day of birth and at 7 days post-birth in the death group were lower than those in the survival group [(63.8±8.5)% vs. (68.7±5.5)%, t=－2.09; (58.0±10.8)% vs. (69.6±4.8)%, t=－4.69; P<0.05], and the proportion of moderate to severe PH was higher than that in the survival group [moderate and severe on the day of birth were 0/10 vs. 33.3% (14/42) and 10/10 vs. 61.9% (26/42), χ2=－2.31; at seven days post-birth were 1/10 vs. 26.2% (11/42) and 9/10 vs. 7.1% (3/42), χ2=4.82; all P<0.05]. Conclusion:Infants with CDH often have circulatory dysfunction after birth, with more severe dysfunction in critically ill CDH infants. The rational use of vasoactive drugs, combined control of persistent pulmonary hypertension of the newborn with multiple drugs, and reasonable volume control may help improve the circulatory function of infants with CDH.
