Eventração diafragmática em recém nascido: relato de caso

Abstract

Diaphragmatic eventration (DE) is a rare pathology, the incidence of which is 1 in 10,000 live births and is characterized by the abnormal elevation of the diaphragm muscles, which may be congenital or acquired. Most EDs are asymptomatic, which often results in underdiagnosis. They can be associated with other malformations and, when symptomatic, can be fatal, especially in the neonatal age group. Thus, this study aims to report the case of a newborn with ED, born in the maternity ward of the University Hospital of the Federal University of Grande Dourados (HU-UFGD). This is a case report, carried out in 2024, based on the clinical case of a newborn, admitted to the HU-UFGD. The study is approved by the HU UFGD Ethics and Research Committee, under opinion number: 6,751,232. The case is about a full-term newborn, born vaginally, to a mother without adequate prenatal care, bathed in thick meconium, with a heart rate below 100 bpm, slow and irregular breathing at birth, requiring resuscitation maneuvers. The patient developed the need for orotracheal intubation, with referral to the neonatal intensive care unit. The chest X-ray showed an elevated diaphragmatic hemi-dome on the right, volumetric reduction of the right lung and parenchymal consolidation in the upper third. A computed tomography of the chest was then requested, in which the following were observed: volumetric reduction of the right lung, consolidations in the posterior regions, associated with elevation of the liver on the right side, with the diagnostic possibility of ED. The patient was kept under observation regarding his breathing pattern, with conservative ED treatment. He remained on mechanical ventilation (MV) for 22 days and, after clinical improvement, was released home on room air, with multidisciplinary monitoring - pediatrician, pneumopediatrician, pediatric surgery and respiratory physiotherapy. The patient had neonatal risk factors - mother without adequate prenatal care and meconium - but developed a serious condition requiring MV for a prolonged period, with a diagnosis of ED on the right after imaging tests. When ED is congenital, it results from incomplete development of the muscular portion or central tendon, or abnormal development of the phrenic nerves, and can affect lung development. Diagnosis for the disease can be carried out prenatally, with high-resolution fetal ultrasound. However, most of the time, the diagnosis is made through radiological findings in a respiratory condition. Management of the disease depends on the severity of the disease and, in symptomatic patients, surgical treatment is recommended, which aims to allow lung expansion in the affected hemithorax and the reversal of atelectasis, with a potential improvement in gas exchange. In cases of clinical treatment, multidisciplinary monitoring is important. This report of ED in a newborn highlights the main features of the disease and the challenges faced in managing this rare and potentially fatal condition. Early identification of ED is important to ensure the best patient care.