Integrated Perinatal Management And Prognosis Of 32 Neonates Prenatally Diagnosed With Congenital Diaphragmatic Hernia

Congenital diaphragmatic hernia(CDH)is a disease caused by hypothyroidal hypoplasia in fetal period.Intra-abdominal organs herniated into the thoracic cavity from the defect and caused poor fetal lung development,resulting in a series of pathophysiological changes.It is a serious threat to the survival of newborns,can cause severe pulmonary dysplasia and persistent pulmonary hypertension,holding a high mortality rate.According to the domestic and foreign research,the incidence of congenital diaphragmatic hernia in neonates is about 1: 2400.There is no exact answer to its etiology and pathogenesis.It may be the result of a combination of genetic and environmental factors.CDH can be divided into Bochdalek hernia,Morgagni's hernia and esophageal hiatus hernia.The latter two species are little impact on lung development,low incidence and high survival rate,with the cause they often have hernia sac,the organs into the chest are limited and have a smaller impact on lung development than Bochdalek hernia.The main symptoms of the latter two are vomiting,abdominal distention,and other digestive symptoms,otherwise respiratory and circulatory disorders are not obvious.Besides,they have low incidence and high survival rate.Therefore,the object of this study is Bochdalek hernia.In recent years,many scholars in domestic and foreign have conducted extensive and in-depth studies on CDH.On the one hand,prenatal ultrasound are used for prenatal diagnosis of CDH,and combine MRI to get more accurate prenatal assessments on the severity of the disease and evaluate treatment effect and prognosis.On the other hand,surgery is still the only cure of CDH,how to choose the timing of surgery and a reasonable surgical method is always the focus of research.In addition,fetal surgical,glucocorticoid application,and ventilator assisted ventilation,pulmonary hypertension,extracorporeal membrane oxygenation(ECMO),artificial patch repair is helpful for children with CDH.However,there is still a high mortality rate in the early postnatal period,reaching 20% to 60%.The most important reason is that the main reason is lung dysplasia,which leads to respiratory and circulatory disorders such as pulmonary hypertension,imbalance of pulmonary ventilation flow rate,eventually leading to high mortality in children after birth.Neonatal surgical diseases often have multiple congenital malformations and chromosomal abnormalities,and imperfect development of multiple organ functions,and early postoperative mortality.The clinical diagnosis and treatment of CDH need the obstetrics,imaging,laboratory,neonatal intensive care,anesthesiology and other related departments,through the combination of ultrasound and magnetic resonance examination to take participate in.Through the combination of ultrasound and magnetic resonance examination,we can make early diagnosis of CDH fetuses,evaluate and check other abnormalities and chromosomal abnormalities,give guidance and appropriate intervention during pregnancy.Besides,we should make radical treatment and strengthening long-term follow-up.Only in this way can we achieve a better results.ObjectiveThis article retrospectively summarizes the clinical data of 32 cases of CHD fetuses treated in our hospital in recent years.Analysis.the research on fetal CHD recently,and formulates a more reasonable disease management path to improve the short-term survival of children with CDH.Materials and methodsThe clinical data of 32 cases of neonatal CDH in our hospital from June 2015 to June 2017 were collected and retrospectively analyzed.All them were diagnosed with CDH in prenatal and accepted treatment in our hospital.They were classified into mild,moderate and severe groups based on prenatal lung area to head circumference(LHR),observed/expected LHR(o/e LHR)and observed/expected total fetal lung volume(o/e FLV).We investigate the neonatal prognosis in different degrees of CDH according to the grouping and the specific circumstances.All subjects received perinatal management program including prenatal management(prenatal diagnosis and consultation),delivery and postnatal management(postnatal diagnosis,neonatal treatment and surgical treatment).SPSS 21.0 statistical software was used for statistical analysis.Counting data are expressed as frequency and rate,and the difference between groups is Chi-square test.Normal distribution of measurement data to(x ± s),draw differents between groups using independent samples t-test.P <0.05 was statistically significant.Results1.All the 32 children with CDH were diagnosed by prenatal ultrasound examination,combination with MRI to prenatal evaluation.Among them,18 cases were mild,9 cases were moderate,and 5 cases were severe.27 cases were left and 5 cases were right.A clear diagnosis was made and group management was performed after birth.After the condition was stable,surgery was performed.2.The overall survival rate of children with congenital convulsions was 81%(26/32).The survival rate of children with severe was 1/5,and the rate of them with mild were 18/18.The more severe the CHD,the lower the survival rate(?2= 16.538,P<0.001).3.Minimally invasive surgery postoperative fasting time,postoperative antibiotic time,hospital stay were shorter than open surgery in the 18 cases of mild CDH.[shortened(2.4 ± 0.5)and(4.6 ± 1.2),T =-3.939;(7.6 ± 1.2)vs(9.8 ± 1.4)d,t =-3.144;(14.4 ± 1.1)vs.(19.7 ± 2.8)d,t=-4.064;P< 0.05]4.Neonates who were discharged alive received a three months to two years postoperative treatment and follow-up,and one received a second operation due to recurrence and all recovered.Conclusions1.The research of CDH perinatal management is of great significance.Through multi-disciplinary collaboration,not only will the fetus with CDH be treated seamlessly,but it will also be helpful to choose the best treatment plan.It conducive to reduce mortality.and improve the prognosis.2.The prenatal ultrasound examination can be used to assess the severity of CDH.The prognosis and prenatal diagnosis are closely related in different degrees of neonatal CDH.The more severe the CHD,the worse the prognosis.3.Laparoscopic minimally invasive congenital diaphragmatic hernia repair compared with the traditional open surgery,in addition to small trauma,beautiful,less complications,still have postoperative early eating,rapid recovery of antibiotics after a short period of time And other advantages,after a rigorous preoperative assessment can be considered minimally invasive applications.