Prediction of outcome in infants with congenital diaphragmatic hernia or severe diaphragmatic eventration.

Congenital diaphragmatic hernia (CDH) and severe congenital diaphragmatic eventration (SDE) still have high mortality. Our aims were to identify clinical prognostic factors for CDH and SDE, and to determine whether the size or area of the proximal bilateral pulmonary arteries (PA) correlate with the clinical outcome. We retrospectively analyzed medical charts of 26 patients--20 with CDH and 6 with SDE, but no obvious other associated anomalies--admitted over a 12-year period. We compared prenatal history, clinical manifestations, blood gas, and echocardiography before surgery in the survivors and the non-survivors. Ten patients (8 CDH, 2 SDE) died 2 to 16 days after birth, including 2 patients without surgery due to progressive hypoxemia. The survivors had significantly higher 1- and 5-min Apgar scores, higher the worst preductal arterial blood gas pH levels, lower oxygen indices, and lower PaCO2 (P < 0.05). The McGoon index of PA size measured by echocardiography was higher in survivors, but not statistically significant. Nakada PA index results, however, were statistically significant (93.07 +/- 32.02 vs. 121.07 +/- 27.08, P < 0.05) In conclusion, Apgar scores, preductal PaCO2, oxygen index, and pH level can predict prognosis in infants with CDH and SDE. The Nakada PA index, however, might be a useful prognostic marker for patients with CDH and SDE.

Successful management of a neonate with Pierre-Robin syndrome and severe upper airway obstruction by long term placement of a laryngeal mask airway.

The severity of airway obstruction varies in infants with Pierre-Robin syndrome (PRS). Some have severe upper airway obstruction that results in respiratory failure and even death. We report a case of neonate with isolated PRS who had a severe airway obstruction and respiratory failure after birth. She had complications of bilateral pneumothorax, subcutaneous emphysema, and hypoxaemia due to difficult tracheal intubation. Respiratory failure recurred immediately after extubation; she was resuscitated by inserting a laryngeal mask airway. The laryngeal mask airway was left inserted for 6 days. It was successful in this patient and eliminated the need for invasive surgical procedures. In conclusion, the relatively long term use of a laryngeal mask airway, which has not been reported before, could be an alternative therapy for patients with PRS with airway obstruction.

Neonatal solitary liver abscess: report of one case.

We report a case of a solitary liver abscess in a 5-week-old female. She was full term, and there were no predisposing events or immune deficiencies. The only sign of her disease was a gradually distended abdomen. A prior episode of fever with possible occult bacteremia was implicated in the development of her abscess. The abdominal sonography and magnetic resonance image (MRI) did not provide any definite preoperative diagnostic information. Surgical resection of the abscess and a short course of antibiotic therapy cured the disease. This patient was still well following 2 years of check-ups by sonography. The possibility of a pyogenic liver abscess should be considered in the differential diagnosis of neonatal hepatic mass. That is, even if there is not a definite diagnostic focus on finding an infection.