Early surgical intervention for diaphragmatic paralysis in a neonate; report of a case and literature review

Diaphragmatic paralysis in newborns is related to brachial plexus palsy. It can cause respiratory failure necessitating prolonged mechanical ventilation and subsequent extubation failure. We present a two-hour-old male newborn with a birth weight of 4500 grams who had a right-sided brachial plexus palsy and right diaphragmatic paralysis due to shoulder dystocia. He developed respiratory distress due to isolated paralysis of the right hemi diaphragm. The clinical course was progressive, his condition worsening despite oxygen application. Physical examination, chest X-rays and M-mode ultrasonography of the diaphragm confirmed the diagnosis diaphragmatic paralysis. Surgical plication of diaphragm was done earlier than the usual time because of recurrent extubation failure. Diaphragmatic plication led to rapid improvement of pulmonary function and allowed discontinuation of mechanical ventilation in less than 3 days. Early diaphragmatic plication enhances weaning process and may prevent or minimize the morbidity associated with long-term mechanical ventilation in a neonate with diaphragmatic paralysis

Sonographic measurement of bladder wall thickness in healthy children

The aim of this study was to determine the ultrasonographic [US] bladder wall thickness [BWT] in normal children. In 106 children [54 boys and 52 girls, aged 8 months to 15 years] without any history and laboratory findings of bladder dysfunction or infection, US measurement of bladder points was performed with bladder filled to at least 50% of its expected capacity. The mean thickness of four bladder wall points was 1.79 +/- 0.28 mm. The mean anterior wall thickness was 1.5 +/- 0.31 mm [range 0.9-2.2 mm], posterior 2 +/- 0.36 mm [range 1.2-3.1 mm], right lateral 1.8 +/- 0.34 mm [ranges 0.8-3mm] and left lateral 1.8 +/- 0.36mm [range 1-3mm]. There was a significant difference between bladder sites [P<0.05] except between lateral sites. We recommend after measurement of four points, to compare these values with normal +/- 2SD curves according to age