[Transposition of great arteries in a newborn with congenital diaphragmatic hernia - case report]

A female newborn was delivered by Caesarean section in 36/37 week of pregnancy, due to prenatally diagnosed congenital diaphragmatic hernia. She was admitted to the intensive care unit in the first minutes of life. It was the first uneventful pregnancy of a 25 year old woman. The newborn's Apgar score was 0, at both 1(st) and 5(th) minute of life. She was immediately intubated, given adrenaline and 4.2% NaHCO(3). High frequency oscillatory ventilation, with high ventilation parameters was initiated. Right-sided pneumothorax was found by auscultation and pleural drainage was installed. On X-ray a left-sided congenital diaphragmatic hernia was noted with presence of the stomach, spleen, small intestine and left lobe of the liver in the thorax. Because of deteriorating clinical condition fluid resuscitation and continuous noradrenaline infusion were used. Despite implemented treatment, severe bradycardia and hypotension developed. Patient died 1.5 hours after birth. On autopsy left-sided diaphragmatic hernia, bilateral pneumothorax, pneumoperitoneum, severe lung hypoplasia and transposition of the great arteries were found. Prenatal diagnosis of cardiac defects by routine ultrasonography may be difficult in a neonate with diaphragmatic hernia, due to altered anatomical conditions. Postnatal echocardiographic examination of the heart is suggested in such infants to exclude the presence of cardiovascular anomalies.