Severe bronchial hyperreactivity as a sequel to congenital diaphragmatic hernia

Bronchial hyperreactivity may be a sequel to congenital diaphragmatic hernia (CDH). V/Q-mismatch in these patients may aggravate the condition. A case history is presented of a 20-month-old girl, who on the second day of life survived surgery for a left CDH. Adrenaline intratracheally via the nasotracheal tube was given to break a condition of refractory bronchospasm and desaturation. In the case of refractory bronchospasm and desaturation adrenaline may be helpful due to its alpha-receptor stimulation as this may inhibit bronchoconstriction, improve the V/Q mismatch and reduce pulmonary vascular resistance and mucosal swelling.