ABSTRACT 405

Abstract

Background and aims: Congenital diaphragmatic hernia is a life threatening anomaly. Aims: We want to present successful management of postoperative pulmonary hypertension by iNO in a newborn with CDH. Methods: Management of postoperative pulmonary hypertension by iNO in a newborn with CDH. Results: A male infant weighing 3000 grams delivered by caesarean section due to fetal distress at 39 gestational weeks. Auscultation of the lungs revealed poor air entry on the left, with a shift of cardiac sounds over the right chest. He was intubated and admitted to NICU because of severe respiratory distress. The first chest X-ray of the patient showed intestinal loops in the left hemithorax with mediastinal shift to right. Therefore, a diagnosis of CDH was confirmed. He was operated on the 2nd day of life. While on conventional ventilation, his oxygen saturation obtained from pulse oxymeter was gradually decreased with high oxygenation index (OI > 30). Echocardiography showed that there was severe pulmonary hypertension (mean pulmonary artery pressure, mPAP=68mmHg). The ventilator mode was changed to high frequency oscillation (HFO) with an initial mean airway pressure of 12 cmH2O, a?P of 28 cmH2O, an oscillation frequency of 8 Hz and 100% oxygen together with 20 p.p.m. iNO. Subsequently, pulmonary hypertension was gradually reduced with OI of <20. The dose of iNO was progressively decreased with no rebounds in mPAP and stopped 8 days from the start. He needed free oxygen for ten days and discharged on the 26th day of surgery. Conclusions: iNO may be useful in the management of pulmonary hypertension developed at early postoperative period.