N GBS X CDH

Some infants with postnatally diagnosed right-sided CDH have been reported to have early-onset GBS sepsis.1 2 The pathophysiology of this association remains unclear. The delayed diagnosis of CDH could be explained by the more subtle pulmonary hypoplasia due to a late herniation, presence of pulmonary opacity or pleural effusion and/or use of positive pressure ventilation.3 For the latter, GBS pneumonia possibly caused a diffusion defect and altered lung compliance requiring mechanical ventilation which, in turn, increased transpulmonary pressures and distended the right lung, giving the illusion of an intact diaphragm at the initial chest X-ray. Once the pneumonia is treated and the neonate is extubated, herniation of intra-abdominal organs into the chest may occur, causing respiratory distress.

Recurrent respiratory distress after neonatal GBS sepsis should raise the suspicion of a congenital diaphragmatic or lung lesion. Similarly, acute perinatal sepsis should be actively pursued in any infant with CDH in whom cardiorespiratory dysfunction is refractory to therapy