Rescue High-Frequency Oscillatory Ventilation for Congenital Diaphragmatic Hernia: What about Lung Histopathology and Necropsy Findings?
Table 5
Histological findings of the six patients whose parents consented to necropsy.
Patient
Characteristics
Necropsy findings
1
Male; 38 weeks GA; 3010 g BW; inborn; left CDH; normal fetal echocardiography; started HFOV on hour 2 of life because of hypercapnia and hypoxia; INO; deceased on day 2 of life.
Coarctation of aorta; lung hypoplasia; bilateral pneumonia; exuberant aspect of hyaline membranes; presence of meconium in alveolar spaces.
2
Male; 36 weeks GA; 2125 g BW; inborn; left CDH; started HFOV on hour 5 of life because of hypercapnia and hypoxia; deceased on day 1 of life.
Lung hypoplasia; liver up; presence of meconium and hyaline membranes in alveolar spaces; small ascitis (15 mL), right pleural (6 mL), and pericardial (1 mL) effusions.
3
Female; 39 weeks GA; 2520 g BW; inborn; bilateral CDH; liver up; started HFOV on hour 2 of life because hypercapnia and hypoxia; INO; ECMO. Operated on day 2; deceased on day 17 on ECMO.
Severe bilateral lung hypoplasia; bilateral pneumonia; generalized haemorrhagic diatesis; ischemic lesions most expressed over the brain, heart, and kidneys.
4
Male; 36 weeks GA; 2230 g BW; outborn; left CDH; liver down; changed to HFOV at hour 24 of life because of hypercapnia; surgery on day 5; deceased on day 11.
Severe left lung hypoplasia; bilateral pleural effusion; bilateral pneumonia; multiorganic lesions suggestive of overwhelming sepsis.
5
Male; 40 weeks GA; 3130 g BW; outborn; C-section because of fetal stress; meconium stained amniotic fluid; right CDH; liver up; started on HFOV on day one because of hypercapnia and hypoxia; surgery on day 2; deceased on D2.
Right lung hypoplasia with de structural malformation of the lower lobe; bilateral pleural effusion (R: 45 mL; L: 10 mL); bilateral lesions of pneumonia; significant meconium aspiration; focal pulmonary haemorrhage.
6
Female; 39 weeks GA; 2600 g BW; inborn; left CDH; left hepatic lobe up; started HFOV on day 1 of life because of hypercapnia; severe pulmonary hypertension; INO; surgery on day 2; deceased on day 14 of life.
Severe left lung hypoplasia; severe muscular hypertrophy of medium and small diameter lung arteries, characteristic of severe pulmonary hypertension.
