A congenital diaphragmatic hernia (CDH) is when the diaphragm in a fetus does not fully develop and as a result the organs in the abdomen are able to slip up into the chest while the fetus is in the womb. The diaphragm is a muscle that helps us breathe and separates the chest cavity from the abdominal cavity. When CDH occurs, the organs in the abdomen compress the lungs, and the lungs do not fully develop. As a result, depending on the severity of the lung compression, the newborn baby with CDH can have problems breathing even after the organs are put back into the abdomen.
Gastrointestinal Tract Birth Defects
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A congenital diaphragmatic hernia (CDH) is most commonly repaired through the abdomen using an incision just below the rib cage. Depending on the size of the hole the surgeon may be able to stitch the hole closed using a primary repair, or, when the defect is too large, using a piece of mesh to patch the hole closed.
Surgeons may use the baby’s own, healthy tissue to close the hole to reduce the chance of the hernia coming back. Surgeons may use a muscle from the baby’s abdomen to close the hole of larger defects. In babies that have well-developed lungs and are more stable, surgeons may use a minimally invasive approach to repair the hernia. In this case, small incisions are made on the chest wall and the hernia can be fixed this way.
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Discovery Health answeredSee All 2 AnswersGastroschisis, which means "belly cleft" in Greek, typically appears as a 2- to 4-centimeter opening of the abdomen, on the right side of the umbilical cord, according to the American Pediatric Surgical Association.
Gastroschisis is less severe than an omphalocele, but is still a dangerous condition that results in death in about 15 percent of cases.
The condition is the most common problem with the abdominal wall. About 40 percent of babies born with gastroschisis are either undersized or are born prematurely.
When a baby has gastroschisis, nothing is covering the baby's exposed intestine, which causes it to come into contact with the amniotic fluid while the fetus is still in the womb. When this occurs, a hard film develops around the intestine. That hinders the newborn's intestinal function and that can last for months.
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See All 2 AnswersOmphalocele, also known as exomphalos, is a birth defect of the abdominal (belly) wall. The infant’s intestines, liver or other organs stick outside of the belly through the belly button. The organs are covered in a thin, nearly transparent sac that hardly ever is open or broken. The Centers for Disease Control and Prevention (CDC) estimates that each year about 775 babies in the United States are born with an omphalocele, or about one out of every 5,386 babies.
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NewYork-Presbyterian Hospital answeredBecause babies with congenital diaphragmatic hernia (CDH) have underdeveloped,or hypoplastic, lungs, they often are unable to breathe at birth. Moreover, the lackof adequate blood vessels in hypoplastic lung tissue results in inadequate blood flow,causing high blood pressure in the lungs—a dangerous condition called pulmonaryhypertension. Because of these critical problems, many newborns with CDH requirehelp breathing from a ventilator.
Ventilators have traditionally been able to sustain about half of babies longenough to undergo and recover from surgery to repair their hernias, and eventually todevelop adequate lung tissue and breathe independently. Those administering theventilation have strived to achieve normal blood levels of oxygen and carbon dioxideby forcing the correct pressure into these tiny babies' lungs. But the application of toomuch pressure can damage undeveloped lungs, leading to sometimes serious, evenfatal, chronic lung disease.
Now, a technique called "kinder and gentler ventilation" has proven superior to thetraditional approach. Developed by Jen-TienWung, MD, Director, Neonatal RespiratoryCare, gentle ventilation seeks to apply the minimum level of respiratory support needed,rather than to achieve normal blood levels of oxygen. Dr.Wung began using lowerventilation pressures in babies with CDH after he observed that lower pressures significantlyimproved survival among babies who aspirated meconium.
Today, the survival rate for babies who receive ventilator support at the MorganStanley Childrens Hospital Neonatal Intensive Care Unit is almost 90%, compared tothe national average of 50-60%. -
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Parkland Medical Center answeredSee All 2 AnswersDuring a routine prenatal ultrasound, your doctor may be able to detect abnormalities with how the diaphragm is developing. An MRI may then be used to take a closer look before diagnosis of congenital diaphragmatic hernia is confirmed. If this birth defect goes unnoticed in a fetus, a diagnosis in a newborn is suspected based on the following symptoms:- difficulty breathing or breathing rapidly
- increased heart rate
- irregular inhaling and exhaling
- sound of bowel in the chest
- breathing noise absent on side with hernia
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Dr. Corey W. Iqbal, MD , Pediatric Surgery, answered on behalf of Overland Park Regional Medical CenterThe outcome for a child with congenital diaphragmatic hernia (CDH) can be long-term problems with breathing, recurrences of the hernia, and feeding/nutrition problems. Therefore, it is important that these babies have access to multiple pediatric specialists even after they have left the neonatal intensive care unit. Most experts quote the expected survival for all babies with CDH to be around 70 to 80 percent.
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Parkland Medical Center answered
A diaphragmatic hernia is a complication that develops in the womb and at birth. With a diaphragmatic hernia there is a gap in the diaphragm muscle where stomach organs squeeze through to crowd the chest cavity and lungs.
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Discovery Health answered
Gastroschisis and omphalocele occur when something goes awry during the development of the organs. About six to 10 weeks after conception, a baby's intestines, liver and stomach jut into the umbilical cord. By the tenth week, the baby's intestines generally go back into the abdomen. Throughout the early stages of development, there is a small opening in the baby's abdominal muscles. This is where the umbilical cord passes through on its way to the placenta. In later stages of development, these abdominal muscles grow together and this tiny opening closes. When the abdominal organs do not return to the abdominal cavity, the muscles fail to close and either gastroschisis or omphalocele results, depending on the severity.
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Discovery Health answered
Doctors use a prenatal ultrasound to diagnose gastroschisis. Upon the baby's birth, doctors take action immediately, administering antibiotics to combat infection. The baby also may be placed in a sterile bowel bag that rises to the chest and insulates the baby from dangerous infections. If the abdomen is large enough at birth to receive the protruding organs, the opening may be surgically closed after birth.
Often, however, the abdomen is too small, so a device known as a preformed silo is used to soften the intestines gradually and then to ease them back into the abdomen. When the baby is a couple of weeks old, surgeons seal the hole. Barring complications, the baby's chances for recovery are good.