eventration of diaphragm and phrenic nerve paralysis

[aagraham]

We are looking for more information and someone who can direct us to a specialist that has experience with infants with eventration of the diaphragm and phrenic nerve paralysis.

My nephew underwent surgery at 3 months of age to repair the right side of his diaphragm.  He orginally presented as failure to thrive (weight loss, increased irritablity)  The surgeon found that the diaphragm appeared to be normal in appearance, except for being stretched.  The internal organs had moved upward in the chest cavity causing atelectasis of the right lung.  They plicated the right diaphragm and re-positioned the organs.  He was initially given a good prognosis, but now we're told we need a miracle!

Currently he remains on a ventilator after failing extubation 3x. He is unable to cough, causing secretions to build up, requiring frequent suctioning. If no improvement, they may do a tracheotomy.

They believe he has unilateral phrenic nerve paralysis probably caused by birth trauma (vaginal delivery with vacuum extraction and meconium aspiration).

Do you have any insight into problems that could be contributing to failure to wean from mechanical ventilation?

In your opinion, what hospital or facility would be best able to treat a case as described above?

Your help and direction will be greatly appreciated.

[National Jewish]

This sounds like a very upsetting and frightening situation for you.  National Jewish Medical and Research Center does not do surgery.  Therefore we do not have the experience to answer your questions.  The best place to go for help would be your local children's hospital and discuss this with the surgeon.

[AndyRRT]

Unfortunately, a tracheostomy is inevitable. the diaphragnm is the major muscle of respiration...without that...you simply cannot ventilate effectively. Even if he were to get extubated, the baby would not be able to mobilize secretions on his own. His cough would be far too weak. This would result in retained secretions, lower oxygen levels and the risk of pneumonia.

Eventration is the malformation of the diaphragm (or the phrenic nerve. This usually leads to prolonged or even chronic ventilator use. Depending upon the severity of the herniation, surgery is limited to a "cure".

-Andy RRT,CPFT