Neonatal intensive care unit on-site surgery for congenital diaphragmatic hernia.

The present study presents the experience gained in the Newborn Intensive Care Unit (NICU) of 'Maria S. Curie' Emergency Clinical Hospital for Children in Bucharest (Romania) after performing a series of bedside surgery interventions on newborns with congenital diaphragmatic hernia (CDH). We conducted a retrospective analysis of the data for all patients operated on-site between 2011 and 2020, in terms of pre- and post-operative stability, procedures performed, complications and outcomes. An analysis of a control group was used to provide a reference to the survival rate for non-operated patients. The present study is based on data from 10 cases of newborns, surgically operated on, on average, on the fifth day of life. The main reasons for operating on-site included hemodynamical instability and the need to administer inhaled nitric oxide (iNO) and high-frequency oscillatory ventilation (HFOV). There were no unforeseen events during surgery, no immediate postoperative complications and no surgery-related mortality. One noticed drawback was the unfamiliarity of the surgery team with the new operating environment. Our experience indicates that bedside surgery improves the likelihood of survival for critically ill neonates suffering from CDH. No immediate complications were associated with this practice.

Ocular pathology associated with obstructive sleep apnea syndrome.

Objective: The purpose of this study was to describe the ophthalmological findings in patients with obstructive sleep apnea syndrome (OSAS). Methods: The study group was made up of 65 patients with OSAS diagnosis and the findings were compared with the ones of the control group (n=39), which comprised patients without OSAS. An observational, analytic study, with a transversal component and a prospective component, was performed. Results: The IOP (intraocular pressure) was similar in both groups (p=0,9786). In the OSAS group, IOP increased with a higher AHI (apnea/ hypopnea index), but not significantly (p=0,057). Similarly, there was no correlation between a higher AHI and the lacrimal secretion in the OSAS group (p=0,3282). However, when we compared control with OSAS patients, we found a significantly higher degree of lacrimal hyposecretion in the latter (p=0,0003). CPAP treatment had no effect on IOP, as initial and final medium IOP were 15.06 and 14.89 respectively (p=0,8327). Regarding lacrimal secretion, it seems that CPAP treatment had an improving effect, as tear production rose from a 9.25 mm medium to 10.45 mm on the Schirmer I test (p=0,0118). Conclusions: Overall, OSAS patients showed similar IOP and glaucoma prevalence as the normal population. However, they had an abnormal tear secretion and a higher prevalence of eyelid laxity (a sign of floppy eyelid syndrome). Abbreviations: OSAS/ SASO = obstructive sleep apnea syndrome, AHI = apnea/ hypopnea index, CPAP = continuous positive airway pressure, FES = floppy eyelid syndrome, TSch/ TSCH = Schirmer test, IOP = intra-ocular pressure, PSG = polysomnography.