The 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.
Gastrointestinal Tract Birth Defects
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Dr. Corey W. Iqbal, MD , Pediatric Surgery, answered on behalf of Overland Park Regional Medical Center -
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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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Initially pyloric stenosis is treated by intravenous hydration due to fluid losses from vomiting. When stable, the patient will undergo a surgical procedure called a pyloromyotomy. This can be done by open incision or laparoscopically and a cut is made in the muscle surrounding the pylorus. -
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Deborah Davis, DNP , OBGYN (Obstetrics & Gynecology), answeredThe signs and symptoms of HPS can mimic those of other conditions that cause infant vomiting, including gastroesophageal reflux disease. Your baby's doctor may use various steps to make the diagnosis: Physical examination- the doctor may feel an olive-shaped lump - the enlarged pyloric muscle; blood tests - a loss of electrolytes may be a sign of continual vomiting and dehydration; Ultrasound- this test is used to create an image of the baby's stomach; Contrast X-ray - contrast material helps any abnormalities show up more clearly on an X-ray. -
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Discovery Health answeredOmphalocele can be diagnosed through ultrasound during pregnancy, but not until after the first trimester. The cause of the defect is not known.
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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.
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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
Small-type omphalocele is estimated to occur in one of every 5,000 births. Large-type omphaloceles occurs in about one in every 10,000 births.
Omphaloceles generally are more dangerous than gastroschisis because in about 25 percent to 40 percent of the cases, they are accompanied by other birth defects. Babies with large-type omphaloceles
Sometimes a small-type omphacele can be repaired through surgery shortly after birth. However, the treatment of large-type omphalocele is more complex. The organs developing outside the body, with a large-type omphalocele, are protected by a membrane, but it is fragile.
If the membrane breaks, the resulting infections are almost always fatal. Complicating matters, the newborn's abdomen is generally too small for surgeons to implant the organs in the body.
To protect the membrane-covered organs in the interim, doctors often employ a treatment called paint and wait. In this treatment, doctors order an antibiotic cream that is applied regularly to the membranes sac which surrounds the organs. As the membrane hardens, skin develops and begins to cover a portion of the organs. Once the baby is bigger and the situation has stabilized, surgeons will close the abdominal cavity, tucking the organs inside.
Although these birth defects can be life-threatening, medical advancements frequently make them treatable.