Congenital Diaphragmatic Hernia

Congenital Diaphragmatic Hernia

Signs and Symptoms
Diagnosis
Treatment

Treatment

Most babies with congenital diaphragmatic hernia (CDH) are born with such small lungs that they cannot breathe on their own. In these cases, your baby will be moved to the Intensive Care Nursery where a mechanical ventilator, which is a breathing machine, will be required to help your baby receive adequate amounts of oxygen. An extracorporeal membrane oxygenation (ECMO) machine, which temporary does the work of breathing for your baby, also may be recommended. It delivers oxygen to your baby's brain and body as temporary support. ECMO is a technique similar to a heart-lung bypass machine, which assists your baby's heart and lung functions with an external pump and oxygenator. Blood is drained from the patient to an artificial lung where oxygen is added and carbon dioxide is removed and then the blood is pumped back into your child.

For babies with CDH in whom the liver has not grown into the chest cavity, survival with treatment after birth is very good, about 90 percent. For these infants, we recommend that the baby be born in a hospital with an Intensive Care Nursery that has the capability to provide ECMO to the infant. ECMO treatment can be used only for a limited time, usually about two weeks.

In the most severe cases of CDH, in whom a portion of the liver has grown into the chest and there is a low lung-to-head ratio (LHR), a ultrasound measure of lung size in CDH, fetal treatment may be considered. As with any fetal surgery, fetuses are considered for intervention only after a normal karyotype, a test that shows that chromosomes are normal and that there are no other defects. Only the most severely affected fetuses with a survival rate estimated at less than 50 percent are offered the option for fetal surgery.

Reviewed by health care specialists at UCSF Children's Hospital.
Last updated May 8, 2007