What is CDH?
The diaphragm is a flat muscle which separates the abdomen and the thorax. It helps in breathing. A diaphragmatic hernia occurs when there is a hole in this flat muscle. The intestine from abdomen will go up in the chest and compress the developing lung.
The hernia is on left side in majority of the cases.
What are the symptoms of CDH?
Breathing problems at birth or within few days of birth is the main symptom. The child may require ventilator support to maintain oxygenation. A few child may present late in life with recurrent respiratory infections and/or vomiting. Sometimes, they are asymptomatic and detected when an x-ray of chest is done for some other reasons.
How common is CDH?
The exact incidence is not known but it occurs in approximately 1 out of 4000 babies.
Which are the tests to confirm the diagnosis?
X-ray of the chest confirms the diagnosis. Sonography and/or CT scan may be required. Echocardiography and blood investigations are also required.
Is it possible to detect this condition during the antenatal period?
Yes, an expert sonologist can detect CDH on anomaly scan during the antenatal period. Sometimes, a fetal MRI may be required to predict the outcome.
What is the treatment?
The definitive treatment of CDH is surgery. The surgery repairs the hole in the diaphragm and restores the normal anatomy.
However, before surgery the newborn with breathing problem must be stabilized in an NICU with ventilator support and medicines. It may take a few days to stabilize the child. Once the child is stabilized, surgery can be performed. After the surgery child may require ventilator support.
What are the risks?
CDH is a physiological emergency. When the baby is having breathing problem, oxygenation may not be optimum and which may cause permanent damage to vital organs like brain. A neonatologist should be available at the time of delivery of the baby (in case of antenatal diagnosis) for the best outcome.
The risks of surgery are bleeding, infection, damage to nearby organs, recurrence (mostly in large defects, patch reinforced closure), respiratory failure and death. The overall survival rates are 60-90%.
What is the long term outcome?
Most babies have an excellent outcome. A few may have recurrent respiratory issues, delayed development and some have gastro-esophageal reflux.