Chest Physiotherapy in a Neonatal Infant After Congenital Diaphragmatic Hernia Surgery

Abstract

Congenital diaphragmatic hernia (CDH) is a rare congenital anomaly. It is characterized with the structural defect of the diaphragm in the intrauterine period. A male neonate with diagnosis of CDH was hospitalized after vaginal delivery at 39 weeks’ gestation. The case was resuscitated and referred to our Neonatal Intensive Care Unit (NICU) on the second day, diagnosed with Bochdalek hernia and underwent surgery. Chest physiotherapy (CP) was started on postoperative 24th day. CP was applied for a total of 24 sessions, twice a day, four days/week, for three weeks, each 30-40 minutes. CP was started with bilateral vibration to the upper apical lobes in modified drainage positions and passive mobilization of the upper limb. CP, performed by positioning the lung lobes in need, consisted of vibration and gentle percussion for 3-5 minutes with distal finger phalanges. Due to the chest X-ray findings, the posterior or lower basal lobes were studied more intensively. Aspiration was performed after physiotherapy in each session. The sessions were ended by placing the patient in side-lying position or a prone position to increase oxygenation. The patient's vital signs, the type and color of secretion, chest radiography, respiratory sounds, nutritional type, and respiratory pattern were evaluated before, during, and after CP. No complications were observed during CP. It was observed that secretion excretion improved, weaning from the mechanical ventilator accelerated, drainage in the chest tube got easier, oral feeding increased, and vital signs didn’t change. Respiratory sounds and chest X-rays showed that the infiltration and atelectasis areas decreased towards the discharge process.