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If your baby is diagnosed with CDH, they will 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.
ECMO is a type of heart-lung bypass. To receive ECMO, your baby will have flexible tubes (cannulas) placed in the blood vessels of the neck that connect to the ECMO machine. Your baby can undergo this procedure from their bed in the NICU.
The ECMO machine works by transferring oxygen-poor blood from your baby’s body through the cannula in the neck and into the machine, where oxygen is added to the blood and carbon dioxide is removed. The ECMO machine returns the oxygen-rich blood to your baby. While on the ECMO machine, your baby will also receive Heparin, a medicine that thins the blood to reduce the risk of a blood clot.
ECMO is used when other treatment options fail. ECMO takes on the job of the heart and lungs while blood pressure in your baby’s lungs decreases. This allows your baby’s heart and lungs to rest. ECMO is considered a temporary measure until your baby’s lung function and pulmonary hypertension improves. If this occurs, your baby will be taken off ECMO.
Repair of the hernia can be done while your baby is on ECMO or after they are taken off ECMO. The hernia repair surgery can be done through an incision (cut) in your baby’s abdomen or through the chest. Your baby’s surgeon will recommend which procedure is best for your baby’s unique condition. If your baby has a large hole, the surgeon may need to use a mesh patch to close the hole.
Following the surgery, your baby will need the same monitoring and support provided in the NICU as they received before the surgery. Your baby may need to remain on the ventilator to help their lungs function and may need medications to lower lung blood vessel pressure and other medications to raise overall blood pressure.
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:
