Congenital diaphragmatic hernia: relationship between defect size and outcome. Experience in a reference centre.

INTRODUCTION: Congenital diaphragmatic hernia (CDH) remains a therapeutic challenge. The surgical classification recommended by the Congenital Diaphragmatic Hernia study group (CDHSG), based on the size of the defect, is used for staging in reference centres. Larger defects are associated with poorer outcomes. Our aim was to describe and compare the morbidity at hospital discharge of newborns who underwent surgical correction of CDH at the Juan P. Garrahan, according to the surgical staging of the defect proposed by the CDHSG. MATERIAL AND METHODS: The study included patients with CDH admitted to the Juan P. Garrahan Hospital between 2012 and 2020, and we analysed the distribution, morbidity and mortality associated with the size of the defect. We carried out a descriptive analysis, calculating measures of central tendency and dispersion, and bivariate and multivariate analyses. RESULTS: A total of 230 patients with CDH were admitted and 158 underwent surgery. We found that defect sizes C and D sizes were associated with an increased risk of chronic pulmonary disease (CPD) (OR, 5.3; 95% CI, 2.2-13.4; P<.0000), need of extracorporeal membrane oxygenation (OR 3.9; 95% CI, 1.3-12.8; P<.005) and chylothorax (OR, 2.1; 95% CI, 0.8-6.4; P<.10]. The multivariate analysis revealed that a large defect size (C-D) was independently and significantly associated with CPD (OR 4.19; 95% CI, 1.76-9.95). CONCLUSION: Staging the defect according to de CDHSG classification during surgery allows the application of uniform management criteria and the prediction of patient outcomes and complications during the hospital stay.

Risk-stratified Results among Congenital Diaphragmatic Hernia Patients in Two Large Extracorporeal Membrane Oxygenation Centers in South America.

INTRODUCTION: Mortality related to CDH is high, but with great variability among centers. There are few studies on patients with this condition born in South America which show poor outcomes. The goal of this study is to present the outcome of CDH in several high-volume quaternary centers in South America, ascertain the factors associated with lower mortality in our population, and compare our outcomes to those of the CDH Study Group (CDHSG). METHODS: The data from two South American centers were retrospectively analyzed and compared with contemporary data from other CDHSG participating centers. Patient demographic and clinical characteristics were also evaluated and compared. RESULTS: Between 2013 and 2018, the two South American centers saw 335 patients with CDH with an overall survival rate of 73.1%. Survival for the high, intermediate, and low-risk groups as determined by the Brindle score was 50%, 70%, and 87%, respectively. In our cohort the strongest predictors of mortality were ECMO use and early PaCO2. There were no significant differences in mortality between the two South American centers and the other CDHSG centers when adjusted by risk score, however, the South American centers had higher use of ECMO in the intermediate-risk group. DISCUSSION: Quaternary South American centers had similar outcomes to CDHSG centers worldwide. The availability and coordination of centralized dedicated care allow more efficient use of scarce technical and professional resources in patients with CDH. LEVEL OF EVIDENCE: III.

Biological versus synthetic patch for the repair of congenital diaphragmatic hernia: 8-year experience at a tertiary center.

PURPOSE: The aim of this study is to compare outcome between small intestinal submucosal (SIS) and polytetrafluoroethylene (PTFE) patches in patients with congenital diaphragmatic hernia (CDH) with large muscular defects. MATERIAL AND METHODS: We performed a retrospective review of prospectively collected data of patients who underwent CDH repair from January 2011 to June 2019, with a minimum follow-up of 1 year. Data were collected regarding length of stay (LOS), mortality and recurrence. Kaplan-Meier analyses was used. RESULTS: In the study period, 195 patients with CDH were admitted, 176 underwent surgical repair and 19 died before surgery. Sixty-two (35%) required a patch. Over the last 5 years, our institution transitioned from the use of all SIS to all PTFE. SIS was used in 18 cases and PTFE in 25. Overall survival rate was 89% (174/195). There was no significant difference regarding LOS and mortality. Nine patients (50%) of SIS and 1 (4%) of PTFE repairs recurred (P < 0.01; log-rank test P <  0.01), with a time course of recurrence of 18 (SD = 13) and 8 months, respectively. Median follow-up was 60 months (SD: 23) for the SIS group and 26 (SD: 10) for the PTFE group. CONCLUSION: A significant lower recurrence was found using PTFE patches instead of SIS for the repair of large CDH. LEVEL OF EVIDENCE: Level 3. Retrospective comparative study.

Diez años del programa de oxigenación por membrana extracorpórea neonatal respiratorio en un hospital público de la Argentina / Ten years of the neonatal respiratory extracorporeal membrane oxygenation program in an Argentinian public hospital

La oxigenación por membrana extracorpórea (extracorporeal membrane oxygenation; ECMO, por sus siglas en inglés) es una terapia de rescate muy invasiva, para pacientes críticamente enfermos. El objetivo es mostrar los resultados de los pacientes tratados con ECMO en el Área de Terapia Intensiva Neonatal del Hospital de Pediatría Juan P. Garrahan, en los primeros diez años del programa, y analizar los factores de riesgo asociados a mortalidad en ECMO. Método. Estudio descriptivo, retrospectivo, con análisis de factores de riesgo. Se incluyeron todos los pacientes tratados con ECMO desde abril de 2008 a febrero de 2019. Resultados. Ingresaron 77 pacientes, 72 recién nacidos y 5 pacientes pediátricos, menores de 1 año. La mediana de edad al ingresar fue de 2días (1-150). Peso: 3200 g±730; edad gestacional: 37,5 semanas ± 4,2; el 53 %, del sexo masculino, y el 50 %, nacidos por cesárea. Los diagnósticos más frecuentes fueron hernia diafragmática congénita y síndrome de aspiración meconial. Sobrevivieron a ECMO 56 pacientes (el 73 %); de estos, fallecieron antes del alta 17 (el 30 %). Las variables asociadas con mortalidad en ECMO fueron la hemorragia en el sistema nervioso central (p: < 0,01), la necesidad de hemodiafiltración (p: < 0,01), el requerimiento de inotrópicos durante ECMO (p: < 0-01) y la presencia de hemorragia sin compromiso del sistema nervioso central (p: < 0-01). Conclusiones. Este estudio refleja los resultados de los primeros 10 años de ECMO respiratoria neonatal. La aparición de complicaciones aumentó la mortalidad durante el procedimiento

Extracorporeal membrane oxygenation (ECMO) is a highly invasive rescue treatment for criticallyill patients. The objective of the study was to show the outcomes of patients treated with ECMO in the neonatal intensive care unit of Hospital de Pediatría Juan P. Garrahan in the first 10 years of the program, and to analyze the risk factors associated with mortality on ECMO. Method. Descriptive, retrospective study with risk factor analysis. All patients treated with ECMO between April 2008 and February 2019 were included. Results. A total of 77 patients were included: 72 neonates and 5 infants younger than 1 year. Patients' median age at admission was 2 days (1-150); weight: 3200 g ± 730 g; gestational age: 37.5 weeks ± 4.2; 53 % were males; and 50 % had been born by C-section. The most common diagnoses included congenital diaphragmatic hernia and meconium aspiration syndrome. Fifty-six patients (73%) survived ECMO; of them, 17 (30 %) died before discharge. The outcome measures associated with mortality on ECMO were central nervous system hemorrhage (p < 0.01), hemodiafiltration requirement (p < 0.01), inotrope requirement during ECMO (p < 0.01), and presence of hemorrhage not affecting the central nervous system (p < 0.01). Conclusions. This study describes the outcomes of the first 10 years of the neonatal respiratory ECMO program. The onset of complications increased mortality during ECMO

Ten years of the neonatal respiratory extracorporeal membrane oxygenation program in an Argentinian public hospital. / Diez años del programa de oxigenación por membrana extracorpórea neonatal respiratorio en un hospital público de la Argentina.

INTRODUCTION: Extracorporeal membrane oxygenation (ECMO) is a highly invasive rescue treatment for critically-ill patients. The objective of the study was to show the outcomes of patients treated with ECMO in the neonatal intensive care unit of Hospital de Pediatria Juan P. Garrahan in the first 10 years of the program, and to analyze the risk factors associated with mortality on ECMO. METHOD: Descriptive, retrospective study with risk factor analysis. All patients treated with ECMO between April 2008 and February 2019 were included. RESULTS: A total of 77 patients were included: 72 neonates and 5 infants younger than 1 year. Patients' median age at admission was 2 days (1-150); weight: 3200 g ± 730 g; gestational age: 37.5 weeks ± 4.2; 53 % were males; and 50 % had been born by C-section. The most common diagnoses included congenital diaphragmatic hernia and meconium aspiration syndrome. Fifty-six patients (73 %) survived ECmO; of them, 17 (30 %) died before discharge. The outcome measures associated with mortality on ECMO were central nervous system hemorrhage (p < 0.01), hémodiafiltration requirement (p < 0.01), inotrope requirement during ECMO (p < 0.01), and presence of hemorrhage not affecting the central nervous system (p < 0.01). CONCLUSIONS: This study describes the outcomes of the first 10 years of the neonatal respiratory ECMO program. The onset of complications increased mortality during ECMO.

La oxigenación por membrana extracorpórea (extracorporeal membrane oxygenation; ECMO, por sus siglas en inglés) es una terapia de rescate muy invasiva, para pacientes críticamente enfermos. El objetivo es mostrar los resultados de los pacientes tratados con ECMO en el Área de Terapia Intensiva Neonatal del Hospital de Pediatría Juan P. Garrahan, en los primeros diez años del programa, y analizar los factores de riesgo asociados a mortalidad en ECMO. Método. Estudio descriptivo, retrospectivo, con análisis de factores de riesgo. Se incluyeron todos los pacientes tratados con ECMO desde abril de 2008 a febrero de 2019. Resultados. Ingresaron 77 pacientes, 72 recién nacidos y 5 pacientes pediátricos, menores de 1 año. La mediana de edad al ingresar fue de 2 días (1-150). Peso: 3200 g ± 730; edad gestacional: 37,5 semanas ± 4,2; el 53 %, del sexo masculino, y el 50 %, nacidos por cesárea. Los diagnósticos más frecuentes fueron hernia diafragmática congénita y síndrome de aspiración meconial. Sobrevivieron a ECMO 56 pacientes (el 73 %); de estos, fallecieron antes del alta 17 (el 30 %). Las variables asociadas con mortalidad en ECMO fueron la hemorragia en el sistema nervioso central (p: < 0,01), la necesidad de hemodiafiltración (p: < 0,01), el requerimiento de inotrópicos durante ECMO (p: < 0-01) y la presencia de hemorragia sin compromiso del sistema nervioso central (p: < 0-01). Conclusiones. Este estudio refleja los resultados de los primeros 10 años de ECMO respiratoria neonatal. La aparición de complicaciones aumentó la mortalidad durante el procedimiento.

Hernia diafragmática congénita: predictores posnatales de mortalidad / Congenital diaphragmatic hernia: postnatal predictors of mortality

La hernia diafragmática congénita (HDC) es una enfermedad de baja prevalencia, con elevada morbimortalidad. Los factores pronósticos posnatales, durante el primer día de vida, son útiles para la toma de decisiones.Objetivos. Determinar la capacidad predictiva de los factores posnatales ecocardiográficos, clínicos y bioquímicos de mortalidad en los recién nacidos con HDC durante el primer día de vida.Método. Estudio observacional analítico de cohorte retrospectiva. Se incluyeron los pacientes con HDC, en forma consecutiva, desde marzo de 2012 a noviembre de 2018. Se analizaron como predictores el índice de oxigenación (IO), valor más alto de presión parcial de dióxido de carbono en sangre (pCO2), puntaje de gravedad SNAPPE II, ecocardiograma, dosaje de NT-pro péptido natriurético B (NT-proPNB), todos medidos en el primer día de vida.Resultados. La población fue de 178 pacientes con HDC. La sobrevida, del 75 %. El 24 % recibió oxigenación por membrana extracorpórea. La presencia precoz de hipertensión pulmonar sistémica o suprasistémica no mostró capacidad predictiva (OR 2,2; IC 95 %: 0,8-8), p = 0,1. NT-proPNB tampoco mostró buena discriminación (área bajo la curva (ABC) 0,46, p = 0,67). El IO, SNAPPE II y el valor más alto de pCO2 mostraron buena discriminación, ABC IO 0,82, ABC SNAPPE II 0,86 y ABC pCO2 0,75, p < 0,001.Conclusión.SNAPPE II, IO y valor más alto de pCO2, medidos el primer día de vida, mostraron buena capacidad predictiva con respecto a la evolución; SNAPPE II fue superior al IO y al valor más alto de CO2.

Introduction: Congenital diaphragmatic hernia (CDH) prevalence is low while its associated morbidity and mortality rates are high. Postnatal prognostic factors on the first day of life are useful for predicting the outcome. Objectives: To determine the mortality predictive ability of postnatal echocardiographic, clinical, and biochemical factors among newborn infants with CDH in their first day of life. Method: Observational analytical study of a retrospective cohort. Patients with CDH were consecutively included between March 2012 and November 2018. On the first day of life, analyzed predictors were the oxygenation index (OI), the highest partial pressure of carbon dioxide (pCO2) level in blood, the SNAPPE II severity score, the echocardiography, and the N-terminal pro-B-type natriuretic peptide (NTproBNP) value. Results: The population consisted of 178 patients with CDH. Survival was 75 %. Extracorporeal membrane oxygenation was used in 24 %. The early onset of systemic or suprasystemic pulmonary hypertension showed no predictive ability (OR: 2.2, 95 % CI: 0.8-8), p = 0.1. NT-proBNP did not show good discrimination either (area under the curve [AUC]: 0.46, p = 0.67). The OI, SNAPPE II score, and the highest pCO2 level showed adequate discrimination power, AUC for OI: 0.82, AUC for SNAPPE II: 0.86, and AUC for pCO2: 0.75, p < 0.001. Conclusion: The SNAPPE II score, the OI, and the highest pCO2 level measured on the first day of life, showed a good predictive ability in terms of the course of the disease; the SNAPPE II score was better than the OI and the highest pCO2 level.

Congenital diaphragmatic hernia: postnatal predictors of mortality. / Hernia diafragmática congénita: predictores posnatales de mortalidad.

INTRODUCTION: Congenital diaphragmatic hernia (CDH) prevalence is low while its associated morbidity and mortality rates are high. Postnatal prognostic factors on the first day of life are useful for predicting the outcome. OBJECTIVES: To determine the mortality predictive ability of postnatal echocardiographic, clinical, and biochemical factors among newborn infants with CDH in their first day of life. METHOD: Observational analytical study of a retrospective cohort. Patients with CDH were consecutively included between March 2012 and November 2018. On the first day of life, analyzed predictors were the oxygenation index (OI), the highest partial pressure of carbon dioxide (pCO2) level in blood, the SNAPPE II severity score, the echocardiography, and the N-terminal pro-B-type natriuretic peptide (NTproBNP) value. RESULTS: The population consisted of 178 patients with CDH. Survival was 75 %. Extracorporeal membrane oxygenation was used in 24 %. The early onset of systemic or suprasystemic pulmonary hypertension showed no predictive ability (OR: 2.2, 95 % CI: 0.8-8), p = 0.1. NT-proBNP did not show good discrimination either (area under the curve [AUC]: 0.46, p = 0.67). The OI, SNAPPE II score, and the highest pCO2 level showed adequate discrimination power, AUC for OI: 0.82, AUC for SNAPPE II: 0.86, and AUC for pCO2: 0.75, p < 0.001. CONCLUSION: The SNAPPE II score, the OI, and the highest pCO2 level measured on the first day of life, showed a good predictive ability in terms of the course of the disease; the SNAPPE II score was better than the OI and the highest pCO2 level.

La hernia diafragmática congénita (HDC) es una enfermedad de baja prevalencia, con elevada morbimortalidad. Los factores pronósticos posnatales, durante el primer día de vida, son útiles para la toma de decisiones. Objetivos. Determinar la capacidad predictiva de los factores posnatales ecocardiográficos, clínicos y bioquímicos de mortalidad en los recién nacidos con HDC durante el primer día de vida. Método. Estudio observacional analítico de cohorte retrospectiva. Se incluyeron los pacientes con HDC, en forma consecutiva, desde marzo de 2012 a noviembre de 2018. Se analizaron como predictores el índice de oxigenación (IO), valor más alto de presión parcial de dióxido de carbono en sangre (pCO2), puntaje de gravedad SNAPPE II, ecocardiograma, dosaje de NT-pro péptido natriurético B (NT-proPNB), todos medidos en el primer día de vida. Resultados. La población fue de 178 pacientes con HDC. La sobrevida, del 75 %. El 24 % recibió oxigenación por membrana extracorpórea. La presencia precoz de hipertensión pulmonar sistémica o suprasistémica no mostró capacidad predictiva (OR 2,2; IC 95 %: 0,8-8), p = 0,1. NTproPNB tampoco mostró buena discriminación (área bajo la curva (ABC) 0,46, p = 0,67). El IO, SNAPPE II y el valor más alto de pCO2 mostraron buena discriminación, ABC IO 0,82, ABC SNAPPE II 0,86 y ABC pCO2 0,75, p < 0,001. Conclusión. SNAPPE II, IO y valor más alto de pCO2, medidos el primer día de vida, mostraron buena capacidad predictiva con respecto a la evolución; SNAPPE II fue superior al IO y al valor más alto de CO2.

Péptido natriurético tipo B: utilidad en el manejo de recién nacidos críticamente enfermos / B-type natriuretic peptide: Usefulness in the management of critically-ill neonates

El péptido natriurético B (PNB) es un péptido responsable de los cambios durante la organogénesis del corazón y en la transición a la vida extrauterina. En la primera semana de vida, los niveles de PNB son altos y se normalizan con el descenso fisiológico del peso. Valores elevados de PNB se han asociado a diferentes patologías. Objetivo. Establecer la relación entre los niveles de PNB y la criticidad y evolución a corto plazo en pacientes internados en la Unidad de Cuidados Intensivos Neonatales. Método. Estudio observacional analítico de una cohorte prospectiva. Se definió criticidad como requerimientos de asistencia respiratoria con fracción inspirada de oxígeno mayor del 50% y/o inotrópicos. Se extrajeron 2 muestras de sangre con 72 h de diferencia. Resultados. Ingresaron 73 pacientes. Según la evolución al séptimo día del ingreso, se los dividió en 2 grupos: pacientes con buena evolución o con evolución grave persistente. La mediana del PNB inicial fue similar en ambos grupos (p: 0,15). La mediana de PNB a las 72 h fue mayor en los pacientes con evolución grave persistente (p: 0,005). Se calculó la diferencia entre ambos valores de PNB (ΔPNB: valor de PNB a las 72 h - valor de PNB a la hora cero). El ΔPNB presentó valores positivos en los pacientes con evolución grave persistente (X= 1260 pg/ml; rango: 4262094) y valores negativos en el grupo con buena evolución (X= -967 pg/ml; rango: -1656/-278) (p: 0,0002); sensibilidad: 87%; especificidad: 86%; valor predictivo positivo: 74%; y valor predictivo negativo: 93%. Conclusión. En este grupo de pacientes, el delta de PNB reflejó la evolución a corto plazo.

B-type natriuretic peptide (BNP) is responsible for changes in the heart organogenesis and is associated with transition to extrauterine life. In the first week of life, BNP levels are high and return to normal with the physiological loss in weight. High BNP levels are associated with different conditions. Objective. To establish the relationship between BNP levels and criticality and the short-term clinical course among patients hospitalized in the neonatal intensive care unit. Method. Observational and analytical study conducted in a prospective cohort. Criticality was defined as a requirement for assisted mechanical ventilation with a fraction of inspired oxygen of more than 50% and/or inotropes. Two blood samples were collected 72 hours apart. Results. Seventy-three patients were included in the study. Depending on their clinical course on day 7, they were divided into 2 groups: patients with a good clinical course or a persistent, severe clinical course. The median baseline BNP level was similar in both groups (p: 0.15). The median BNP level at 72 hours was higher among patients with a persistent, severe clinical course (p: 0.005). The difference between both BNP values was calculated (ΔBNP: BNP level at 72 hours - BNP level at 0 hours). The ΔBNP was positive among patients with a persistent, severe clinical course (X= 1260 pg/mL; range: 426-2094) and negative in the group with a good clinical course (X= -967 pg/mL; range: -1656/-278) (p: 0.0002); sensitivity: 87%; specificity: 86%; positive predictive value: 74%; and negative predictive value: 93%. Conclusion. In this group of patients, the delta-BNP value reflected the short-term clinical course.

B-type natriuretic peptide: Usefulness in the management of critically-ill neonates. / Péptido natriurético tipo B: utilidad en el manejo de recién nacidos críticamente enfermos.

INTRODUCTION: B-type natriuretic peptide (BNP) is responsible for changes in the heart organogenesis and is associated with transition to extrauterine life. In the first week of life, BNP levels are high and return to normal with the physiological loss in weight. High BNP levels are associated with different conditions. OBJETIVE: To establish the relationship between BNP levels and criticality and the short-term clinical course among patients hospitalized in the neonatal intensive care unit. METHOD: Observational and analytical study conducted in a prospective cohort. Criticality was defined as a requirement for assisted mechanical ventilation with a fraction of inspired oxygen of more than 50% and/or inotropes. Two blood samples were collected 72 hours apart. RESULTS: Seventy-three patients were included in the study. Depending on their clinical course on day 7, they were divided into 2 groups: patients with a good clinical course or a persistent, severe clinical course. The median baseline BNP level was similar in both groups (p: 0.15). The median BNP level at 72 hours was higher among patients with a persistent, severe clinical course (p: 0.005). The difference between both BNP values was calculated (ΔBNP: BNP level at 72 hours - BNP level at 0 hours). The ΔBNP was positive among patients with a persistent, severe clinical course (X= 1260 pg/mL; range: 426-2094) and negative in the group with a good clinical course (X= -967 pg/mL; range: -1656/-278) (p: 0.0002); sensitivity: 87%; specificity: 86%; positive predictive value: 74%; and negative predictive value: 93%. CONCLUSION: In this group of patients, the delta-BNP value reflected the short-term clinical course.

INTRODUCCIÓN: El péptido natriurético B (PNB) es un péptido responsable de los cambios durante la organogénesis del corazón y en la transición a la vida extrauterina. En la primera semana de vida, los niveles de PNB son altos y se normalizan con el descenso fisiológico del peso. Valores elevados de PNB se han asociado a diferentes patologías. OBJETIVO: Establecer la relación entre los niveles de PNB y la criticidad y evolución a corto plazo en pacientes internados en la Unidad de Cuidados Intensivos Neonatales. MÉTODO: Estudio observacional analítico de una cohorte prospectiva. Se definió criticidad como requerimientos de asistencia respiratoria con fracción inspirada de oxígeno mayor del 50% y/o inotrópicos. Se extrajeron 2 muestras de sangre con 72 h de diferencia. RESULTADOS: Ingresaron 73 pacientes. Según la evolución al séptimo día del ingreso, se los dividió en 2 grupos: pacientes con buena evolución o con evolución grave persistente. La mediana del PNB inicial fue similar en ambos grupos (p: 0,15). La mediana de PNB a las 72 h fue mayor en los pacientes con evolución grave persistente (p: 0,005). Se calculó la diferencia entre ambos valores de PNB (ΔPNB: valor de PNB a las 72 h - valor de PNB a la hora cero). El ΔPNB presentó valores positivos en los pacientes con evolución grave persistente (X= 1260 pg/ml; rango: 4262094) y valores negativos en el grupo con buena evolución (X= -967 pg/ml; rango: -1656/-278) (p: 0,0002); sensibilidad: 87%; especificidad: 86%; valor predictivo positivo: 74%; y valor predictivo negativo: 93%. CONCLUSIÓN: En este grupo de pacientes, el delta de PNB reflejó la evolución a corto plazo.

[Late diagnosis bilateral congenital diaphragmatic hernia: a case report]. / Hernia diafragmática congénita bilateral de diagnóstico tardío: reporte de un caso.

Congenital diaphragmatic hernia (CDH) is a rare malformation, usually unilateral and left sided. Bilateral CDH (B-CDH) represents 1% of all CDH. Mortality is higher in right side and bilateral defects. We report a case of a patient with Bilateral CDH, initially diagnosed and treated as unilateral right CDH. At 8 months during a laparoscopic Ladd procedure a left side CDH was found.

La hernia diafragmática congénita (HDC) es una malformación rara, habitualmente unilateral y más frecuente del lado izquierdo. La HDC bilateral representa el 1% de todas las HDC. La mortalidad es mayor en las HDC derechas y en las bilaterales. Reportamos el caso de un paciente con HDC bilateral, cuya malformación inicialmente se diagnosticó y trató como una HDC derecha. Luego se encontró la presencia de HDC izquierda durante la cirugía de Ladd laparoscópica a los 8 meses de edad.

Hernia diafragmática congénita bilateral de diagnóstico tardío: reporte de un caso / Late diagnosis bilateral congenital diaphragmatic hernia: a case report

La hernia diafragmática congénita (HDC) es una malformación rara, habitualmente unilateral y más frecuente del lado izquierdo. La HDC bilateral representa el 1% de todas las HDC. La mortalidad es mayor en las HDC derechas y en las bilaterales. Reportamos el caso de un paciente con HDC bilateral, cuya malformación inicialmente se diagnosticó y trató como una HDC derecha. Luego se encontró la presencia de HDC izquierda durante la cirugía de Ladd laparoscópica a los 8 meses de edad.

Congenital diaphragmatic hernia (CDH) is a rare malformation, usually unilateral and left sided. Bilateral CDH (B-CDH) represents 1% of all CDH. Mortality is higher in right side and bilateral defects. We report a case of a patient with Bilateral CDH, initially diagnosed and treated as unilateral right CDH. At 8 months during a laparoscopic Ladd procedure a left side CDH was found.

[Staphylococcus aureus methicillin-resistant community acquired neonatal orbital cellulitis]. / Celulitis orbitaria neonatal por Staphylococcus aureus meticilinorresistente de la comunidad.

Orbital cellulitis typically occurs in older children, but it can occasionally affect infants and neonates. Staphylococcus aureus is the main pathogen isolated. Outcome depends on an adequate initial approach. We report three neonates with orbital cellulitis caused by community-associated MRSA.

Celulitis orbitaria neonatal por Staphylococcus aureus meticilinorresistente de la comunidad / Staphylococcus aureus methicillin-resistant community acquired neonatal orbital cellulitis

La celulitis orbitaria es una patología del niño mayor y raramente compromete al período neonatal. Staphylococcus aureus (SA) es el principal agente etiológico relacionado. El diagnóstico precoz y el tratamiento adecuado mejoran el pronóstico. Se presentan tres recién nacidos con celulitis orbitaria por SA meticilinorresistente de la comunidad (SAMR-CO).

Orbital cellulitis typically occurs in older children, but it can occasionally affect infants and neonates. Staphylococcus aureus is the main pathogen isolated. Outcome depends on an adequate initial approach. We report three neonates with orbital cellulitis caused by community- associated MRSA.

Celulitis orbitaria neonatal por Staphylococcus aureus meticilinorresistente de la comunidad / Staphylococcus aureus methicillin-resistant community acquired neonatal orbital cellulitis

La celulitis orbitaria es una patología del niño mayor y raramente compromete al período neonatal. Staphylococcus aureus (SA) es el principal agente etiológico relacionado. El diagnóstico precoz y el tratamiento adecuado mejoran el pronóstico. Se presentan tres recién nacidos con celulitis orbitaria por SA meticilinorresistente de la comunidad (SAMR-CO).(AU)

Orbital cellulitis typically occurs in older children, but it can occasionally affect infants and neonates. Staphylococcus aureus is the main pathogen isolated. Outcome depends on an adequate initial approach. We report three neonates with orbital cellulitis caused by community- associated MRSA.(AU)

Celulitis orbitaria neonatal por Staphylococcus aureus meticilinorresistente de la comunidad. / [Staphylococcus aureus methicillin-resistant community acquired neonatal orbital cellulitis].

Orbital cellulitis typically occurs in older children, but it can occasionally affect infants and neonates. Staphylococcus aureus is the main pathogen isolated. Outcome depends on an adequate initial approach. We report three neonates with orbital cellulitis caused by community-associated MRSA.