Anaesthetic Management of a 4-Day-Old Neonate with Congenital Diaphragmatic Hernia: A Case Report

Congenital Diaphragmatic Hernia (CDH) is a life-threatening condition characterised by the herniation of abdominal organs into the thoracic cavity through a diaphragmatic defect, leading to pulmonary hypoplasia and Persistent Pulmonary Hypertension (PPHN). This case report highlights the perioperative anaesthetic management of a 4-day-old, 2.5 kg neonate with left-sided CDH and severe pulmonary hypertension undergoing surgical repair. The neonate was intubated immediately after birth due to respiratory distress and was managed with Synchronised Intermittent Mandatory Ventilation (SIMV). Cardiopulmonary support was provided using infusions of milrinone, sildenafil, and dobutamine. After stabilisation, surgical repair was performed on day four of life. Anaesthesia was induced with sevoflurane and oxygen under spontaneous respiration to minimise barotrauma, transitioning to controlled anaesthesia with atracurium following bowel exteriorisation. A caudal epidural catheter was placed for intraoperative and postoperative analgesia using 0.1% ropivacaine. Following surgery, the neonate remained on SIMV with gradual weaning from respiratory support, achieving successful extubation by postoperative day three. Regular monitoring and a multidisciplinary approach ensured stabilisation and optimal recovery. This case underscores the importance of comprehensive perioperative strategies in managing neonates with CDH. Key measures include careful preoperative stabilisation, use of spontaneous ventilation during anaesthesia induction to reduce lung trauma, and effective analgesia using caudal epidural techniques. Combining these interventions with cardiopulmonary support can significantly improve outcomes in this high-risk population.