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Congenital diaphragmatic hernia (CDH) is a health condition in which a baby is born with a hole in their diaphragm (the muscle that separates the chest from the abdomen). Typically, the heart and lungs are positioned in the chest and the intestines and other organs are in the abdomen (belly). Due to the hole in the diaphragm, the abdominal organs can move into the chest and crowd the heart and lungs.
As the baby grows in the womb during pregnancy, their lungs are compressed (squeezed) by the abdominal organs in the chest. This makes it more difficult for the lungs to develop. As a result, your baby may have trouble breathing once they’re born. In addition, CDH causes the blood vessels of the lungs to be thicker, making it difficult for blood to pick up oxygen in the lungs.
CDH occurs more commonly on the left side of the body and the size of the hole in the diaphragm can vary. The cause of CDH is still unknown.
Symptoms and complications of CDH after birth can include:
Almost all cases of CDH are diagnosed during routine prenatal (pregnancy) ultrasounds. Your OB/GYN may notice a possible issue on your ultrasound – such as a mass – in your developing baby’s chest and refer you to a Maternal-Fetal Medicine (MFM) specialist for additional ultrasound tests, consultation and imaging. MFM specialists will work to quickly diagnose CDH. They will perform a comprehensive review to ensure that your baby’s CDH is not part of a larger problem, and they will coordinate follow-up care as needed.
The following may be performed:
After birth, your baby may need to undergo one or more of the following tests:
If your baby is diagnosed with CDH during pregnancy, you will need to plan to deliver at a hospital with a neonatal intensive care unit (NICU) experienced in caring for babies with CDH, like Orlando Health Winnie Palmer. After birth, your baby may experience serious complications, needing the care of an experienced neonatologist.
Your baby will also need surgery to move the intestines back into the belly and repair the hole in the diaphragm. Although surgery will correct your baby’s CDH, it is important to know that it will not cure their breathing problems. Breathing problems are a result of the baby’s smaller lung size, which can cause pulmonary hypertension (condition that causes increased pressure in the arteries of the lungs).
The main goal of treatment directly after birth is to support breathing (bringing oxygen into the body and getting rid of carbon dioxide) without causing permanent and severe damage to the lungs. Below are treatments we offer for CDH.
Soon after birth, your baby will be admitted to the NICU. They will have a breathing tube placed using a ventilator to regulate their breathing, provide oxygen and get rid of carbon dioxide.
A tube is placed through your baby’s mouth and into their stomach to drain air or fluid, as a full stomach can compress the lung and cause additional breathing problems. Your baby will receive medicines through an intravenous (IV) line in their vein to help them relax, manage pain and reduce pressure in the lung. Catheters (thin tubes) may also be placed in your baby’s veins or arteries to deliver medications and draw blood to check oxygen levels.
After your baby is treated for CDH and discharged home from Orlando Health Winnie Palmer, our team will continue to offer support for your family. Keeping your baby as healthy as possible is our ongoing goal. You will have access to our follow-up clinic with support from the following pediatric specialties:
If your developing baby is diagnosed with CDH during your pregnancy, it is natural for you to have many questions and likely, some concerns. The experts at the Congenital Chest Disorders Clinic, part of the Fetal Care Center, at Orlando Health Winnie Palmer Hospital for Women & Babies are here to provide compassionate, world-class care in a family-centered setting. Our team has years of experience in successfully treating CDH in babies and we are here to support you every step of the way.
The Congenital Chest Disorders Clinic at Orlando Health Winnie Palmer uses a multidisciplinary team approach to caring for pregnant mothers and developing babies with CDH. Maternal-fetal medicine specialists will coordinate care with neonatologists and pediatric specialists from Orlando Health Arnold Palmer. The team will provide you with options and work with you to develop a care plan personalized to your baby’s unique diagnosis.
Our team includes:
The Congenital Chest Disorders Clinic is comprised of a multidisciplinary team of experts from Orlando Health Winnie Palmer in partnership with pediatric specialists from Orlando Health Arnold Palmer Hospital for Children.
Orlando Health Winnie Palmer and Orlando Health Arnold Palmer are recognized for excellence in perinatal (before birth) and neonatal care:
When you choose the Congenital Chest Disorders Clinic, you can be confident our team will help you throughout your journey – from diagnosis to delivery – and provide specialized care for your newborn baby. We believe that you are a critical part of your baby’s care team, and we work to continually keep you involved and informed.