Search

Background: The ideal nutritive strategy for a neonate with congenital diaphragmatic hernia (CDH) has not been elucidated. The purpose of this study was to investigate the efficacy of early parenteral nutrition (PN) in CDH neonates. Methods: Thirty‐five CDH neonates admitted to a single hospital from January 2005 to December 2014 were retrospectively reviewed. For the first 4 years of the study period, neonates received non‐early PN (n‐EPN) (2005–2008, amino acids [AA] <1.0 g/kg/day, no lipids administered). After the transitional period (TP) (2009–2011, AA 1.0–2.5 g/kg/day, lipid 1.0 g/kg/day), early PN (EPN) (2011–2014, AA ≥3.0 g/kg/day, lipid 1.0 g/kg/day) was performed. We investigated the clinical effect of PN for growth‐associated clinical variables and the outcomes. Results: The first day of AA administration was late in the n‐EPN period (6.0 ± 4.6, 0.0 ± 0.8, 0.1 ± 0.3 ; n‐EPN, TP, EPN: in order). The final day of PN (11.0 ± 3.7, 9.2 ± 4.0, 12.4 ± 3.9) and the first day of enteral feeding (4.5 ± 1.9, 4.3 ± 1.4, 4.5 ± 3.2), the first day of full milk feeding (100 mL/kg/day) (10.8 ± 5.4, 9.2 ± 2.3, 11.5 ± 3.5) were statistically equal in every period. The date and body weight at discharge showed no significant differences among the three groups, but the weight‐gain rate from birth to discharge was higher in the EPN group than in the n‐EPN group (P = 0.023). The rate of inhaled nitric oxide (NO) gas administration and the duration of ventilation showed no significant differences among the three groups. Severe PN‐associated liver disease was not noted during the observation period. Conclusions: Early PN for CDH neonates promotes weight gain in the neonatal intensive‐care unit. The long‐term efficacy and safety of EPN for CDH neonates should be elucidated by additional studies. [ABSTRACT FROM AUTHOR]

A 37-year-old (G4P3) woman was referred to our hospital at 32 weeks of gestation for the evaluation of a fetus with an intrathoracic cystic lesion. Ultrasonography and magnetic resonance imaging revealed that a fetal cystic lesion without a mucosal layer was located in the posterior mediastinum. These findings were consistent with a bronchogenic cyst. At 38 3/7 weeks of gestation, an elective cesarean section was performed because of her previous cesarean section. A female neonate without any external anomalies, weighing 2,442 g, with Apgar scores of 8 and 9, and requiring no resuscitation was born. Four weeks after delivery, the neonate was admitted because of respiratory distress due to mass effect. At right lateral thoracotomy, a 105 × 65 mm of solitary smooth-walled cyst containing serosanguineous fluid was found in the posterior mediastinum, which was excised completely. Histologic examination revealed the diagnosis of the mediastinal gastric duplication cyst. The neonate made an uneventful recovery. Accurate diagnosis is not necessary, but detection and continuous observation are logical. Although gastric duplication, particularly intrathoracic, is a rare pathology, it should be considered in the differential diagnosis of any intrathoracic cyst. [ABSTRACT FROM AUTHOR]