Management of XXXX and @entity4501 in the neonate with severe @entity649 .

@entity1 @entity4501 @entity1152 @entity649 @entity5274 @entity292 @entity356
In a 10-year period, 22 neonates with @entity1152 ( @entity1152 ) and @entity4501 ( @entity4501 ) required high pressure ventilatory support soon after birth because of @entity649 ( @entity649 ). Eleven of the 22 or 50% survived overall, but if the 5 @entity1 who died before definitive surgical repair could be attempted are excluded, 11 of 17 or 65% survived. More importantly, 4 of 7 (57%) @entity1 who had gastrostomy performed first survived while 7 of 10 (70%) who had @entity292 ligation performed first survived. The difficulties with intraoperative management of those who had gastrostomy performed first were even more impressive. Our experience leads us to conclude that @entity1 with @entity1152 and @entity4501 with severe @entity649 who require high pressure ventilation preoperatively represent a group of @entity1 who require special consideration. The danger to such @entity1 with increased pulmonary resistance is not @entity356 but sudden loss of intragastric pressure. In the presence of poor lung compliance, the upper gastrointestinal tract functions in continuity with the tracheobronchial tree. A sudden loss of intragastric pressure, as with placement of a @entity5274 , results in an acute loss of effective ventilating pressure. Resuscitation of such a @entity1 is not possible until leakage from the esophagus is controlled by ligation of the @entity292 or transabdominal occlusion of the distal esophagus. Placement of a Fogarty catheter into the @entity292 via a bronchoscope is effective but may not be feasible in every case. Early thoracotomy and ligation of the @entity292 in @entity1 with progressive @entity649 provides immediate improvement in ventilatory efficiency and relief of @entity356 .
