PREOPERATIVE STABILIZATION OF INFANTS BORN WITH CONGENITAL DIAPHRAGMATIC HERNIA  : A CASE REPORT

Putu Enggi Pradana Putra; Adinda Putra Pradhana; Kadek Agus Heryana Putra

doi:10.31004/prepotif.v9i3.49457

Authors

Putu Enggi Pradana Putra Anesthesiology and Intensive Care Department Resident, Medical Faculty of Udayana University /Prof. dr. I.G.N.G. Ngoerah General Hospital
Adinda Putra Pradhana Anesthesiology and Intensive Care Department Assistant Professor, Medical Faculty of Udayana University / Udayana University Hospital
Kadek Agus Heryana Putra Anesthesiology and Intensive Care Department Assistant Professor, Medical Faculty of Udayana University / Prof. dr. I.G.N.G. Ngoerah General Hospital

DOI:

https://doi.org/10.31004/prepotif.v9i3.49457

Keywords:

hernia diafragma kongenital, neonatus, stabilisasi preoperatif

Abstract

Hernia diafragma kongenital adalah kelainan bawaan langka, di mana organ perut masuk ke rongga toraks akibat defek pada diafragma. Pada praktik kedokteran saat ini, penundaan operasi hingga stabilisasi kardiorespiratori tercapai terlebih dahulu mulai dipopulerkan. Pasien merupakan neonatus aterm (37–38 minggu) dengan distress napas 10 menit setelah lahir. Skor Apgar 7 dan 6 pada menit ke-1 dan ke-5, tangisan tidak teratur, tubuh kemerahan, dan ekstremitas sianosis. Bunyi peristaltik terdengar di hemitoraks kiri, dan foto toraks menunjukkan hernia diafragma kongenital kiri dengan pergeseran mediastinum. Pasien mendapat ventilasi dengan mode volume control/assist control (VC/AC): fraksi oksigen (FiO₂) 35%, laju napas 40, positive end-expiratory pressure (PEEP) 6, mempertahankan saturasi oksigen perifer (SpO₂) 91–99%. Setelah pasien stabil, dilakukan laparotomi dengan anestesi umum. Premedikasi berupa atropin dan fentanil, induksi dan pemeliharaan menggunakan oksigen, sevofluran, dan udara terkompresi. Analgesia pascaoperasi diberikan fentanil dan parasetamol. Evaluasi pascaoperasi menunjukkan suara napas kiri membaik dan bunyi peristaltik menghilang. Pasien dirawat di NICU selama tiga hari, kemudian lima hari di ruang rawat biasa sebelum pulang. Penundaan operasi memberikan waktu adaptasi terhadap hipoplasia paru dan kontrol hipertensi pulmonal. Mekanisme proteksi paru yang meliputi volume tidal rendah dan hiperkapnia yang ditoleransi penting untuk mengurangi komplikasi. Kasus ini menegaskan pentingnya penundaan operasi hingga setelah stabilisasi pada hernia diafragma kongenital.

References

Baschat, A. A., Desiraju, S., Bernier, M. L., Kunisaki, S. M., & Miller, J. L. (2024). Management advances for congenital diaphragmatic hernia: integrating prenatal and postnatal perspectives. Translational Pediatrics, 13(4), 643–662. https://doi.org/10.21037/tp-23-602

Chandrasekharan, P. K., Rawat, M., Madappa, R., Rothstein, D. H., & Lakshminrusimha, S. (2017). Congenital Diaphragmatic hernia – a review. Maternal Health, Neonatology and Perinatology, 3(6). https://doi.org/10.1186/s40748-017-0045-1

Davis, P. J., & Cladis, F. P. (2021). Smith’s Anesthesia for Infants and Children (10th Editi). Elsevier.

DeKoninck, P. L. J., Horn-Oudshoorn, E. J. J., Knol, R., Crossley, K. J., & Reiss, I. K. M. (2021). Knowledge Gaps in the Fetal to Neonatal Transition of Infants With a Congenital Diaphragmatic Hernia. Frontiers in Pediatrics, 9. https://doi.org/10.3389/fped.2021.784810

Dillon, P. W., Cilley, R. E., Mauger, D., Zachary, C., Meier, A., Altman, R. P., Gaines, B., Glick, P., Caniano, D., & Donahoe, P. (2004). The Relationship of Pulmonary Artery Pressure and Survival in Congenital Diaphragmatic Hernia. Journal of Pediatric Surgery, 39(3), 307–312. https://doi.org/10.1016/j.jpedsurg.2003.11.010

Dumpa, V., & Chandrasekharan, P. (2023). Congenital Diaphragmatic Hernia. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK556076/

George, A., & Joshi, S. (2013). Anesthetic management of a case of congenital diaphragmatic hernia; delayed diagnosis. Medical Journal of Dr. D.Y. Patil University, 6(3), 281. https://doi.org/10.4103/0975-2870.114644

Greer, J. J. (2013). Current concepts on the pathogenesis and etiology of congenital diaphragmatic hernia. Respiratory Physiology and Neurobiology, 189(2), 232–240. https://doi.org/10.1016/j.resp.2013.04.015

Guidry, C. A., Hranjec, T., Rodgers, B. M., Kane, B., & McGahren, E. D. (2012). Permissive Hypercapnia in the Management of Congenital Diaphragmatic Hernia: Our Institutional Experience. Journal of the American College of Surgeons, 214(4), 640–647. https://doi.org/10.1016/j.jamcollsurg.2011.12.036

Guner, Y. S., Harting, M. T., Fairbairn, K., Delaplain, P. T., Zhang, L., Chen, Y., Kabeer, M. H., Yu, P., Cleary, J. P., Stein, J. E., Stolar, C., & Nguyen, D. V. (2018). Outcomes of infants with congenital diaphragmatic hernia treated with venovenous versus venoarterial extracorporeal membrane oxygenation: A propensity score approach. Journal of Pediatric Surgery, 53(11), 2092–2099. https://doi.org/10.1016/j.jpedsurg.2018.06.003

Haroon, J., & Chamberlain, R. S. (2013). An evidence-based review of the current treatment of congenital diaphragmatic hernia. Clinical Pediatrics, 52(2), 115–124. https://doi.org/10.1177/0009922812472249

Lakshminrusimha, S., Keszler, M., & Yoder, B. (2022). Care of the infant with congenital diaphragmatic hernia. In M. Keszler & K. S. Gautham (Eds.), Assisted Ventilation of the Neonate (Seventh Ed, pp. 446–457). Elsevier.

Lakshminrusimha, S., & Vali, P. (2020). Congenital diaphragmatic hernia: 25 years of shared knowledge; what about survival? Jornal de Pediatria, 96(5), 527–532. https://doi.org/10.1016/j.jped.2019.10.002

McCann, M. E., Greco, C., & Matthes, K. (2018). Essentials of Anesthesia for Infants and Neonates. Cambridge University Press.

Moore, S. S., Keller, R. L., & Altit, G. (2024). Congenital Diaphragmatic Hernia: Pulmonary Hypertension and Pulmonary Vascular Disease. Clinics in Perinatology, 51(1), 151–170. https://doi.org/10.1016/j.clp.2023.10.001

Pranata, H., & Kurniyanta, P. (2021). Anesthesia management of congenital diaphragmatic hernia in neonates. Bali Journal of Anesthesiology, 5(1), 53–56. https://doi.org/10.4103/BJOA.BJOA_192_20

Quinney, M., & Wellesley, H. (2018). Anaesthetic management of patients with a congenital diaphragmatic hernia. BJA Education, 18(4), 95–101. https://doi.org/10.1016/j.bjae.2018.01.001

Sferra, S. R., Guo, M., Salazar, A. J. G., Penikis, A. B., Engwall-Gill, A. J., Ebanks, A., Harting, M. T., Collaco, J. M., & Kunisaki, S. M. (2023). Sex-Specific Differences in Congenital Diaphragmatic Hernia Mortality. The Journal of Pediatrics, 259, 113481. https://doi.org/10.1016/j.jpeds.2023.113481

Singh, Y., & Lakshminrusimha, S. (2021). Pathophysiology and Management of Persistent Pulmonary Hypertension of the Newborn. Clinics in Perinatology, 48(3), 595–618. https://doi.org/10.1016/j.clp.2021.05.009

Snoek, K. G., Reiss, I. K. M., Greenough, A., Capolupo, I., Urlesberger, B., Wessel, L., Storme, L., Deprest, J., Schaible, T., Van Heijst, A., Tibboel, D., Allegaert, K., Debeer, A., Keijzer, R., Benachi, A., Tissieres, P., Kipfmueller, F., Schaible, T., Breatnach, C., … Davenport, M. (2016). Standardized postnatal management of infants with congenital diaphragmatic hernia in Europe: The CDH EURO Consortium Consensus - 2015 Update. Neonatology, 110(1), 66–74. https://doi.org/10.1159/000444210

Traynor, M. (2024). Lung-protective ventilation in the management of congenital diaphragmatic hernia. World Journal of Pediatric Surgery, 7(2), e000789. https://doi.org/10.1136/wjps-2024-000789