An infant is in the NICU being managed for CDH, and surgical closure is
planned. In discussing management of the case with the anesthesia fellow, you
explain that:
a) An increase in the preductal saturation during the case may indicate increased
pulmonary vascular resistance
b) Oligohydramnios is commonly seen prenatally in infants with CDH
c) Correction of the CDH usually fully resolves the associated pulmonary
hypertension symptoms
d) Herniation of the liver is associated with a poor prognosis
e) In addition to adequate oxygenation, maintenance of a high-normal EtCO2 is
important because of associated pulmonary hypertension
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Answer
Answer d. Most CDH patients have some degree of pulmonary hypertension
related to altered lung development; correcting the herniation does not resolve
these findings, although they may improve. In the setting of pulmonary
hypertension, hypocarbia and alkalosis probably improve pulmonary vascular
resistance and cardiac output. Oligohydramnios is unusual. Herniation of the
stomach and liver, as well as a history of polyhydramnios, are associated with a
poorer prognosis.
Notes
- This question originally printed in the Pediatric Anesthesiology Review Topics kindle book series, and appears courtesy of Naerthwyn Press, LLC.
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