congenital diaphragmatic hernia

1st day of life, p/w respiratory distress..

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Diagnosis :- congenital diaphragmatic hernia right side. Possible complication: severe PPHN. MANAGEMENT: 1. Intubate and ventilate. Ensure sats > 95%. Provide as much ventilation and oxygen to support higher sats. Aim is to avoid PPHN. If PPHN sets in, its very difficult to manage. You may need Sildenafil, iNO or HFOV later. 2. Monitor blood pressure, possibly invasively. Start Inotropes to keep BP> 55 Atleast. Get cardiologist to do Echo to check Pulmonary pressures, then aim systemic pressure higher than that. 3. Fluids 60 ml/kg/day. 4. Sedation with Morphine infusion, start with 20mcg/kg/hr after a bolus. Helps avoid PPHN. 5. Keep pH > 7.4, may need Bicarb infusion for the same. 6. Once baby stabilises, then aim for surgical correction. 7. Put NG tube, aspirate as much air, and leave NG on free drainage. 8. Consider baseline antibiotics and sepsis screen. Its a long way to surgery and stability... supporting parents is paramount. Good luck. Keep us updated with blood reports.

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Congenital diaphragmatic hernia TRANSFER TO THE PEDIATRIC SURGEON FOR BETTER TREATMENT AND MANAGEMENT.

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Rt.diaphrgamatic hernia

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Right sided eventration of diaphragm with intestines in thorax . Left lung collapse

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@Nirav Garasiya Placing an endotracheal (ET) tube into the baby's windpipe. Mechanical breathing machine (to do the work of breathing for the baby) Supplemental oxygen (extra amounts of oxygen) Continuous positive airway pressure (CPAP). ... Surfactant replacement with artificial surfactant

Diaphragmatic hernia, ref to pediatrics surgeon

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