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Diaphragmatic paralysis and eventration in infants
The Journal of Thoracic and Cardiovascular Surgery
|April 1, 1986
Summary
Phrenic nerve injury in infants is a serious complication, especially after surgery. Plication surgery for eventration can be life-saving, but high mortality persists in complex cases.
Area of Science:
- Pediatric Surgery
- Neonatology
- Thoracic Surgery
Background:
- Eventration of the diaphragm presents significant challenges in infants.
- Congenital, birth trauma, and iatrogenic phrenic nerve injuries contribute to infant eventration.
- Associated anomalies and prematurity are common in affected infants.
Observation:
- Operative phrenic nerve injury occurred in 12 infants under 3 months, frequently during Blalock-Taussig shunt procedures.
- Plication surgery was performed on 21 infants, most with respiratory distress or ventilator dependence.
- Four patients required repeat plication; successful extubation within one week was critical for survival.
Findings:
- Plication, via thoracic or abdominal approaches, is a safe procedure.
- Mortality was high (67%) among infants undergoing plication, with eventration complications contributing to death in many cases.
- Failure to extubate within a week post-plication indicated a poor prognosis.
Implications:
- The incidence of iatrogenic phrenic nerve injury in infants undergoing lateral thoracotomy needs greater awareness.
- Eventration management in infants with significant comorbidities carries a high mortality risk, even with surgical intervention.
- Early extubation post-plication is a key indicator of successful outcomes in infant diaphragmatic eventration.