a Longer operative time

b Reduced post-op PRBC transfusions

c Reduced time on ECMO

d Increased risk of hernia recurrence

e Increased reoperations for bleeding[/size]

a Treprostinil

b Sodium Nitroprusside

c Milrinone

d Sildenafil

e Inhaled Nitric Oxide[/size]

"After the hernia is reduced, an attempt is made to visualize the ipsilateral lung. This is usually done by retracting the anterior rim of the diaphragm. Often, a hypoplastic lung can be observed at the apex. A hernial sac, composed of pleura and peritoneum, is present in about 20% of patients. The sac, if present, is excised to avoid leaving a loculated, space-occupying lesion in the chest"

"Three easily detectable features—polyhydramnios, mediastinal shift, and the absence of an intra-abdominal stomach bubble—should prompt a more careful search for herniated abdominal organs in the chest. Polyhydramnios is present in about 80% of the pregnancies with fetuses who have CDH and has also been associated with poor outcome. Routine antenatal ultrasound detects approximately 50–85% of cases of CDH. Lung-to-head ratio (LHR), the ratio of contralateral lung area to head circumference, measured by antenatal ultrasound, is used to predict the severity and outcome in CDH and to predict patients with poor outcome for antenatal intervention."

What is the next best step in this infant’s management?

A Change formula

B Video fluoroscopic swallow study

C Laparoscopic Nissen fundoplication

D Placement gastrostomy tube

[/size]

[center]Thoracoscopic repair of left Bochdalek hernia.

See video in 2nd post[/center]

[center]Laparoscopic assisted repair of Morgagni hernia

See video in 2nd post[/center]