Journal of pediatric surgery
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Phrenic nerve injury with resulting diaphragm paralysis occurred in 25 (1.5%) of 1,656 cardiac surgical procedures in children during a 10-year period. Phrenic nerve injury was most commonly noted in patients who had undergone previous cardiac surgery (16 of 165, 10%; P < .0001), typically after a previous Blalock-Taussig shunt (10 of 53, 19%; P = .007). Plication of the diaphragm (7 thoracic, 4 abdominal) was performed in 11 patients (44%). ⋯ There were no deaths as a direct result of phrenic nerve injury. Phrenic nerve injury after cardiac surgery is a serious complication that often leads to respiratory insufficiency in patients under than 2 years of age. For such patients, early diaphragm plication is a simple and effective procedure that prevents the complications of prolonged mechanical ventilation.
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Case Reports
Extracorporeal membrane oxygenation in pediatric respiratory failure secondary to smoke inhalation injury.
Extracorporeal membrane oxygenation (ECMO) was used successfully in two children who had respiratory failure secondary to smoke inhalation injury. The first involved a 20% body surface area burn with initial carboxyhemoglobin of 26%. The patient developed varicella pneumonia, which complicated his respiratory failure; he was placed on ECMO for 7 days. ⋯ He underwent debridement and allografting while on ECMO, and was decannulated after 13 days. Anticoagulation for ECMO did not significantly interfere with dressing changes. Both patients had definitive autografting and were discharged home breathing room air.
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Pulmonary hemorrhage (PH) occurs infrequently as a complication in neonates with respiratory failure. Major PH has been observed at the authors' institution in several neonates after "successful" completion of extracorporeal life support (ECLS) therapy. The authors sought to determine the incidence of PH and the risk factors associated with this unique and newly described morbidity after ECLS. ⋯ Higher SGPT (185.4 +/- 146.4 U/L v 22.6 +/- 3.5 U/L; P < .05) and BUN (69.3 +/- 7.5 mg/dL v 47.2 +/- 5.9 mg/dL; P < .05) also were noted for the patients with PH. PH represents an important and novel morbidity in neonates after ECLS. Prolonged acidosis, a high fluid requirement before ECLS, the need for blood pressure support during ECLS, and evidence of renal and/or hepatic dysfunction serve to identify patients who have a high risk for the development of this complication.