Congenital Diaphragmatic Hernia
A congenital diaphragmatic hernia (CDH) occurs when the muscle separating the chest and the abdomen, the diaphragm, does not form completely.
What is a Congenital Diaphragmatic Hernia?
Congenital means a condition that is present at birth. Diaphragmatic hernia is an opening in the diaphragm. The diaphragm is the muscle that separates the chest and the abdomen.
Unlike babies who are born with other types of hernias, babies born with diaphragmatic hernias need prompt treatment. Diaphragmatic hernias occur when the organs that are normally in the abdomen push through or intrude into the baby's chest cavity.
This is a problem because the lungs do not have the space they need to develop and expand properly. Babies born with diaphragmatic hernias have trouble breathing and getting enough air. Doctors will assess a newborn's health and provide the infant with the additional oxygen and breathing support they need before any surgery to fix the defect is done.
How is a Congenital Diaphragmatic Hernia diagnosed?
A prenatal diagnosis can be made by fetal ultrasound. If a prenatal diagnosis is made, a prenatal consultation should be obtained at a center where the infant can be well treated. The infant should either be delivered at or rapidly transferred to a center well versed and capable of caring out all of the treatment modalities for such infants.
What are the causes of a Congenital Diaphragmatic Hernia?
The exact cause behind diaphragmatic hernias is not known but genetic defects play a role in the disorder. Babies born with diaphragmatic hernia have skin that appears blue (cyanosis), and may have trouble breathing – they may make grunting sounds as a result.
Congenital diaphragmatic hernia affects boys and girls, equally. Sometimes, babies don't have any other congenital problems, but some babies with diaphragmatic hernia also have complex syndromes that can complicate treatment. CDH has a significant mortality risk, in the range of 40%, based on the degree of respiratory compromise.
Because your baby’s lungs did not develop normally, sometimes, all best possible methods of oxygen exchange are unsuccessful. The baby might need Extra Corporeal Membrane Oxygenation (ECMO).
With ECMO, catheters are placed in the artery and vein, or just in the vein, of the neck. This is done to move the baby’s blood and exchange oxygen through a heart-lung machine outside the body. This action carries significant risks and complications. Those can include stroke, bleeding and infection.
To give your baby the best chance at survival, we recommend delivery at a hospital that has a trained resuscitation team.
How is a Congenital Diaphragmatic Hernia treated?
Babies that have breathing problems receive immediate treatment, including mechanical ventilation (breathing support) and continuous monitoring of all vital signs. Medications such as relaxants and pain relievers help stabilize a newborn with diaphragmatic hernia until the baby is healthy enough to have surgery to fix the defect.
Once your baby is stable, surgery is done. The surgery replaces the organs where they were meant to be, if this is possible. Also the opening in the diaphragm is closed. If the opening is too large, a mesh can be used to patch the opening.
With prompt care and advanced surgical techniques, most children do very well. After surgery, children benefit from continued medical care and support to ensure good health.