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Pulmonary function in newborns after repair of congenital diaphragmatic hernia
Author(s) -
Nakayama Don K.,
Motoyama Etsuro K.,
Mutich Rebecca L.,
Koumbourlis Anastassios C.
Publication year - 1991
Publication title -
pediatric pulmonology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.866
H-Index - 106
eISSN - 1099-0496
pISSN - 8755-6863
DOI - 10.1002/ppul.1950110109
Subject(s) - medicine , congenital diaphragmatic hernia , pulmonary function testing , bronchodilator , vital capacity , pulmonary hypoplasia , anesthesia , lung volumes , pulmonary compliance , cardiology , respiratory system , lung , asthma , lung function , diffusing capacity , gestation , pregnancy , fetus , genetics , biology
Congenital diaphragmatic hernia (CDH) is associated with pulmonary hypoplasia that limits survival, but the nature and extent of pulmonary dysfunction in neonates with CDH have not been studied. We performed pulmonary function tests (PFTs) in eight intubated infants who survived neonatal repair of CDH (wt, 3.33 ± 0.15 kg; age, 20.1 ± 2.7 d; mean ± S.E.M.). PFTs obtained from six full‐term infants (wt, 3.56 ± 0.10 kg; age, 25.0 ± 3.3 d) with no respiratory illness served as controls. The deflation flow‐volume curve technique produced maximum expiratory flow‐volume (MEFV) curves, giving reproducible measurements of forced vital capacity (FVC) and maximal expiratory flow at 25% of FVC (MEF 25 ). Respiratory system compliance (Crs) and resistance (Rrs) were obtained with a modified passive mechanics technique. In seven of eight infants PFTs were repeated after nebulized bronchodilator (0.1% isoetharine). In neonates surviving CDH repair, as compared to those with normal lung function, FVC was significantly reduced (20.78 ± 3.32 vs. 39.83 ± 3.30 mL · kg −1 , P < 0.05). MEF 25 was also markedly reduced (8.41 ± 1.46 vs. 32.32 ± 4.35 mL · kg −1 · s −1 , P < 0.05), indicating lower airway obstruction. After administration of nebulized bronchodilator, PFTs showed significant increases from control values in both FVC (15.9%) and MEF 25 (200%) without changes in Crs and Rrs. These findings indicate that neonates with CDH have restrictive lung defects, reflecting hypoplasia. After surgical repair and mechanical ventilation airway reactivity develops, primarily in smaller airways, and this may complicate the postoperative course. Pediatr Pulmonol. 1991 ; 11 :49‐55.