[Primary management of newborn infants with respiratory failure due to a congenital defect of the diaphragm].

The authors report on 36 premature and term infants with congenital defects of the diaphragm, including 17 patients who developed a severe respiratory insufficiency either immediately after birth or during the first 30 minutes of life. The overall mortality rate was 64%; the results of treatment were marked by a particularly high mortality rate among the patients with early respiratory insufficiency: out of 17 patients, 12 died. The evaluation of the courses confirmed that adequate preoperative primary care is of major prognostic importance in patients with early respiratory insufficiency. On the basis of personal experience the authors have formulated the following recommendations for improving diagnosis and therapy at this stage of care: greater use of sonography examination methods for antepartal diagnosis of congenital defects of the diaphragm, making it possible to treat the corresponding high-risk pregnancies at an early stage in clinics equipped for neonatologic and pediatric surgical treatment; early intubation respiration with a ventilation technique which does not overstrain the patient, in newborns with abnormal respiration and suspected congenital defects of the diaphragm; the great diagnostic importance of plain radiographs of the thorax and abdomen; neonatologic and intensive medical stabilization treatment in patients with severely suppressed metabolism prior to the anesthesiologic and surgical stress of closure of the diaphragm defect.