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NICU guideline identifier

Surgery - management of congenital diaphragmatic hernia in the neonate

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Overview

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. See PICU's protocol

Preoperative care

  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 

  1. Follow standard steps for post-operative care and the chest drain protocol.

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Document Control

  • Date last published: 31 January 2005
  • Document type: Clinical Guideline
  • Services responsible: Neonatology, Paediatric Surgery
  • Owner: Newborn Services Clinical Practice Committee
  • Editor: Sarah Bellhouse
  • Review frequency: 2 years