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Logo of archdischfnArchives of Disease in Childhood - Fetal & NeonatalVisit this articleSubmit a manuscriptReceive email alertsContact usBMJ
Arch Dis Child Fetal Neonatal Ed. 2007 September; 92(5): F418.
PMCID: PMC2675374

Newborn with intermittent grunting in the first hours after delivery

A newborn baby boy (42 weeks' gestation with good start, Apgar scores 9,10) developed intermittent grunting with slight subcostal retractions in the first hours after birth. At first heart sounds were audible on the left side, but within two hours these shifted to the right side of the chest. The baby's colour changed from pink to pale. A chest x ray (fig 11)) showed a left diaphragmatic hernia with displacement of the heart to the right side due to intestinal loops in the left thorax. A thoracoscopy was carried out. There was a small defect in the left posterolateral diaphragm, which was closed primarily without a patch (figs 22 and 3). The baby was rapidly extubated and oral feeding started. A chest x ray taken on the fourth postoperative day showed almost normal findings.

figure fn111294.f1
Figure 1 Chest x ray before referral to the neonatal intensive care unit. Large amounts of intestines in the left thorax are seen pushing the lung tissue towards the apex and the heart to the right. The stomach is in the abdominal cavity, but ...
figure fn111294.f2
Figure 2 (A) Thoracoscopic view of the abdominal cavity through the diaphragmatic defect. Several intestinal loops are seen in the thorax, and the lung is collapsed. (B) Thoracoscopic closure of the diaphragmatic defect with Ethibond 3×0 ...

Diaphragmatic hernia has a spectrum of presentations, ranging from non‐symptomatic to a life‐threatening situation immediately after birth. Symptomatic hernias are treated by surgical closure of the posterolateral defect. With the advent of minimal invasive surgery, in patients with stable cardiorespiratory status, the defect may be closed through a laparoscopic or thoracoscopic approach with or without the use of a patch.1,2 In the present case the baby had an envelope‐like defect, which was suitable for primary closure. The case illustrates nicely the minimal invasive closure of the diaphragmatic hernia using a thoracoscopic approach.


Competing interests: None declared.


1. van der Zee D C, Bax N M. Laparoscopic repair of congenital diaphragmatic hernia in a 6‐month‐old child. Surg Endosc 1995. 91001–1003.1003 [PubMed]
2. Becmeur F, Talon I, Schaarschmidt K. et al Thoracoscopic diaphragmatic eventration repair in children: about 10 cases. J Pediatr Surg 2005. 401712–1715.1715 [PubMed]

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