Background: The optimal timing of surgery for left-sided mild-to-moderate congenital diaphragmatic hernia (CDH) remains unknown. Objectives: To determine the optimal timing of surgery for left-sided mild-to-moderate CDH. Methods: Thirty newborns were randomly divided into emergency (EAR) and delayed (DEL) surgery groups. Thoracoscopic repair of CDH was performed within 48 hours after birth in the EAR group and then in the DEL group. Next, the baseline data, primary and secondary endpoints, and adverse reactions were assessed. Results: Differences between the two groups were not significant in terms of the measured lung-to-head ratio (LHR), preoperative pulmonary artery hypertension (PAH)-free/mild PAH ratio, surgery duration, duration of postoperative mechanical ventilation, incidence of postoperative moderate-to-severe PAH, postoperative mortality, and recurrence rate in the follow-up (P > 0.05 for all). Meanwhile, age at surgery (P = 0.001), duration of fasting (P = 0.001), and hospital stay (P = 0.032) were significantly different between the two groups. Conclusions: Timing of thoracoscopy, performed within 85 hours of birth for left-sided CDH repair, does not affect the therapeutic outcomes of children with left-sided mild-to-moderate CDH.

Background: Pneumomediastinum is an emergency pediatric disease. A severe tension pneumomediastinum can result in respiratory and circulatory dysfunction. However, few papers describe surgical methods to treat tension pneumomediastinum in a normative manner.Methods: We did a case-control study of 104 pediatric patients with tension pneumomediastinum and comorbid type II respiratory failure. Fifty-two patients were treated with a drainage strip being inserted into the pre-tracheal space while other 52 patients were treated without drainage. Arterial blood pO2 and pCO2 after 30 minutes and 12 hours of mechanical ventilation, chest radiography results after 12 hours of mechanical ventilation, and the length of stay in PICU of the two groups were analyzed by paired t-tests and Chi-square.Results: Chest radiography after 12 hours of mechanical ventilation showed that the pneumomediastinum basically disappeared in the surgery group but did not decrease significantly in the control group. The arterial blood pCO2 after 12 hours of mechanical ventilation and the length of stay in PICU were significantly lower in the surgery group than in the control group (p<0.001, p<0.001), while the arterial blood pO2 after 12 hours of mechanical ventilation was significantly higher in the surgery group than in the control group (p<0.001). There were no significant intergroup differences in other variables. No recurrence occurred in either group during 7–14 days after discharge, and all patients recovered.Conclusions: Our method for draining tension pneumomediastinum improved respiratory function and shortened the length of stay in PICU.Trial registration: ChiCTR2000039496. Date of registration: 2021/2/25 (retrospectively registered).