| BackgroundThe most obvious pathological manifestation of congenital diaphragmatic hernia(CDH)is the defect of the diaphragm,and the herniation of the abdominal organs into the chest cavity,which affects the normal development of the lung.The mortality rate of severe CDH is 70%.ObjectiveTo summarize the procedure of diagnosis and treatment of neonatal congenital diaphragmatic hernia with the multidisciplinary diagnosis and treatment mode and to explore the risk factors for poor prognosis of neonatal diaphragmatic hernia under this mode.MethodsThe clinical data of 73 neonates with congenital diaphragmatic hernia who received multidisciplinary diagnosis and treatment in our research center from April 2014 to July 2020 were retrospectively analyzed.The results included gender,gestational age at diagnosis,gestational age at birth,birth weight,diaphragmatic hernia location,liver location,operation timing,operation duration,operation method,Apgar score,preoperative PaCO2,and postoperative blood pH.The 73 children were divided into good prognosis group(54 cases)and poor prognosis group(19 cases),and the risk factors of poor prognosis were analyzed by univariate analysis and multivariate Logistic regression.ResultsAmong 73 cases of CDH,58 cases were on the left side and 15 cases were on the right side;63 cases were found by prenatal diagnosis,with an average gestational age of prenatal diagnosis of(26.76 ± 5.14)w,an average birth weight of(2.90±0.66)kg and an average gestational age at birth of(37.06 ± 2.59)w;10 cases were diagnosed by chest X-ray due to postnatal respiratory distress;54 cases survived and 19 cases died.In six years,the overall survival rate of children was 73.9%,which increased from 60%in 2014 to 92.9%in 2020;the postoperative survival rate of children was 77.1%,which increased from 60%in 2014 to 92.9%in 2020;the survival rate of minimally invasive endoscopic surgery was 89.3%,which increased from 50%in 2014 to 100%in 2020.Univariate and multivariate logistic regression analysis showed that low birth weight,open surgery,gestational age at diagnosis≤25w,operation timing<24 h were risk factors for poor prognosis(all P<0.05).ConclusionThe multidisciplinary diagnosis and treatment mode of CDH is helpful to improve the overall survival rate of CDH and effectively improve the prognosis of children.Low birth weight,,gestational age at diagnosis≤25w,operation timing<24h were risk factors for neonatal diaphragmatic hernia.Thoracoscopic diaphragmatic repair should be given priority when the surgeon is experienced.BackgroundCongenital diaphragmatic hernia is a kind of severe congenital structural malformation caused by unilateral or bilateral diaphragmatic defects and herniation of abdominal organs into the chest due to abnormal diaphragmatic development during embryo.Despite the continuous improvement of prenatal diagnosis and perioperative management,the mortality rate of children with severe CDH remains high,with pulmonary hypoplasia and pulmonary hypertension as the main cause of death.Prenatal application of retinoic acid can improve pulmonary hypoplasia in CDH fetal rat,and prenatal application of sildenafil can improve pulmonary vascular dysplasia in CDH fetal rat.The present study hypothesized that prenatal combination of retinoic acid with sildenafil could further promote lung development in CDH fetal rat.ObjectiveTo study the effects of prenatal application of retinoic acid and/or sildenafil on lung development in CDH rat models induced by nitrofen.MethodsCDH was induced by intragastric gavage of nitrofen(100mg)at 9.5 days of pregnancy in SD rats.Twenty pregnant SD rats were randomly divided into 5 groups:(1)Control group-C;(2)Nitrofen blank group-N;(3)Nitrofen+Retinoic acid group-NR:5mg/kg/d retinoic acid was dissolved in 1ml olive oil by gavage on 18.5-20.5 days of pregnancy;(4)Nitrofen+Sildenafil group-NS:17.5-20.5 days 100mg/kg/d sildenafil dissolved in 1ml olive oil by gavage;(5)Nitrofen+Retinoic acid+Sildenafil-NRS:retinoic acid 5mg/kg/d on days 18.5-20.5,sildenafil 100mg/kg/d on days 17.5-20.5,dissolved in 1ml olive oil by gavage.On day 21.5 of gestation,the fetal rats were removed by caesarean section,the diaphragmatic hernia was observed and the lung weight to body weight ratio(LW/BW)was recorded.The mean terminal bronchi density(MTBD),vascular media wall thickness(MWT),axial acinar count(RAC),the number of small vessels and interalveolar septal thickness were detected.ResultsRetinoic acid significantly reduced the teratogenic rate of CDH(N 45.6%vs.NR 25.4%;NS 53.8%vs.NRS 25.9%,both P<0.05).Compared with Nitrofen blank group,Nitrofen+Retinoic acid group significantly increased RAC,decreased MTBD and interalveolar septal thickness,and had no significant changes in other indexes.The number of small blood vessels in CDH fetal rat was significantly increased,MTBD and MWT were significantly decreased in the Nitrofen+Sildenafil group,and other indexes had no significant changes.The RAC and the number of small blood vessels in CDH fetal rat of Nitrofen+Retinoic acid+Sildenafil group was significantly increased,while MTBD,MWT and interalveolar septal thickness were significantly decreased.Most lung tissues of CDH fetal rat in NRS group developed from tubule stage to vesicle stage,but did not reach the development state of normal group.ConclusionRetinoic acid can significantly improve the development of alveoli and promote lung maturation in fetal rats with congenital diaphragmatic hernia.Prenatal sildenafil has positive effects on improving pulmonary vascular structure,alleviating vascular remodeling and promoting angiogenesis in fetal rats with congenital diaphragmatic hernia.In a CDH rat model,prenatal combination of retinoic acid and sildenafil has complementary effects on lung parenchyma and vascular development. |
PDF Full Text Request