4th Pediatric Infectious Diseases Conference
 
 
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FIND DIAGNOSIS
FIND DIAGNOSIS
Find Diagnosis
Pedi Poll
Today's Poll
Should teicoplannin, colistin be used in case of neonatal sepsis where culture does not reveal any organism_?
No, it should be used only after drug sensitivity report
Yes, under guidance of an infectious disease expert
CONGENITAL DIAPHRAGMATIC HERNIA
CONGENITAL DIAPHRAGMATIC HERNIA
Dr Sunita Goel
Lecturer in Anaesthesiology
BJ Wadia Childrens hospital
 

Management in Delivery Room and NICU

Intubate
Intubate
  • Avoid ventilation with Ambu bag or mask.
  • Risk of gastric distention, which will further compromise respiratory and cardiac function
Positive Pressure Ventilation
Positive Pressure Ventilation (see Table 2)
  • Hyperventilation. Maintain pH > 7.5.
  • Peak inspiratory pressure < 30 cm H2O (watch for pneumothorax)
  • High frequency ventilation
Passage of NG tube to decompress stomach
Passage of NG tube to decompress stomach
IV access and fluid resuscitation
IV access and fluid resuscitation

 Additional treatment modalities :
Extracorporeal Membrane Oxygenation
Extracorporeal Membrane Oxygenation : Current guidelines are unclear.
Aims of therapy
Aims of therapy :
  • To limit airway pressure and oxygen toxicity
  • To eliminate shunting
  • To reverse systemic hypoxemia
  • To reduce pulmonary blood flow
  • To allow gradual expansion of lung
Problems with ECMO
Problems with ECMO :
  • Technical complications in 20% of patients
    • Tubing rupture or disconnection
    • Clotting disorders
    • Air embolism
    • Oxygenator failure
    • Heat exchanger malfunction
    • Power failure
    • Malpositioning of cannula
    • Inadvertent decannulation
  • 10% human error
    • Open air entry port (potentially fatal)
    • Blood loss due to disconnection
  • Extremely labor intensive (12 to 34 ECMO specialists recommended)

 
Neonatology : Expertise Views
Neonatology : Expertise Views
Neonatology : Expertise Views
Neonatology : Expertise Views
 
 
Educational Section
 
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