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Abstract: A parent brought a 3-month-old baby to the hospital. The parent described that the baby presented with shortness of breath accompanied by crying 3 hours ago. After examination, chest X-ray and oxygen saturation, the diagnosis of congenital diaphragmatic hernia was confirmed. After 14 days of treatment and care, the child’s dyspnea and shortness of breath disappeared and he was discharged.
Basic information】Female, 3 months old
Disease Type】Congenital diaphragmatic hernia
Hospital】The First Affiliated Hospital of Kunming Medical University
Date of Consultation】November 2021
Treatment plan】Oxygen therapy + surgery (diaphragmatic hernia repair)
Treatment Period】14 days of hospitalization, 2 months of follow-up
Results】The diaphragmatic hernia repair was successful, and the child was discharged from the hospital with symptoms of dyspnea and shortness of breath.
I. Initial consultation
One day, an anxious and tired woman came to the clinic with her 3-month-old baby in her arms. The parents described that the baby had developed shortness of breath three hours ago, accompanied by crying and could not be coaxed. After careful examination of the child’s condition, it was found that the baby did have symptoms of shortness of breath, shortness of breath and rapid breathing, without cyanosis or vomiting. The results showed that the mediastinum was right shifted, the lungs were compressed, the left chest was abnormal, and the diaphragm was incomplete, which was highly suspected to be a congenital diaphragmatic hernia, and the baby was admitted to the hospital with “congenital diaphragmatic hernia”.
Treatment history
After the child was admitted to the hospital, we continued to improve routine blood tests, blood glucose, blood lipids, liver and kidney functions, electrolytes, oxygen saturation, etc. We found that the oxygen saturation was lower than normal, and no metabolic acidosis was observed. After consultation with the family, in order to relieve the child’s respiratory distress as soon as possible, it was decided that oxygen therapy would be used to improve the child’s oxygen saturation, and then diaphragmatic hernia repair would be performed after the condition had stabilized. After the diaphragmatic hernia repair, the baby’s symptoms gradually improved, and the dyspnea gradually disappeared. The baby was discharged on the 14th day of admission with no significant abnormalities in all indicators.
Treatment effect
After admission to the hospital, the baby received active symptomatic treatment, and the symptoms of dyspnea were quickly controlled and relieved, and the diaphragmatic hernia was successfully repaired. On the 14th day of admission, the patient basically recovered to a healthy state, with normal respiratory rate, no shortness of breath or shortness of breath, and no significant abnormality in the chest X-ray and all indexes on review. During the follow-up period, the family indicated that the child was healthy and had no abnormalities.
IV. Notes
As an attending physician, we were pleased that the child recovered to good health after 14 days of active treatment and careful care, and no longer had shortness of breath or shortness of breath. In addition to regular follow-up, parents should pay attention to changes in the baby’s breathing, heart rate, crying and face color. The mother should follow the principle of small amount and many times when feeding him/her to avoid choking and coughing to trigger the increase of pressure in the abdominal cavity or induce lung infection. Avoid going to crowded places as much as possible, go out for protection and go home for disinfection to strictly prevent respiratory infections.
V. Personal insight
Congenital diaphragmatic hernia, which can be diagnosed prenatally by ultrasonography, can usually be detected in the 24th week of pregnancy. Therefore, it is recommended that pregnant women have prenatal checkups on time during pregnancy to understand fetal development, detect abnormalities early, and develop emergency plans early. In addition, it is recommended to avoid exposure to factors that may cause fetal abnormalities, such as tobacco, alcohol and radiation during pregnancy. Congenital diaphragmatic hernia can sometimes induce serious complications, such as pulmonary hypertension and metabolic acidosis, which can endanger the life of the child. Therefore, parents should pay more attention to their baby’s status and seek medical attention in time to get the best timing for surgery and reduce the sequelae and pain of the child once abnormalities are detected.