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What Is A Diaphragmatic Hernia?

 

A: A diaphragmatic hernia is a birth defect in which there is an abnormal opening in the diaphragm, the muscle that helps you breathe. The opening allows part of the organs from the belly (stomach, spleen, liver, and intestines) to go up into the chest cavity near the lungs.

More than 1600 babies are born with congenital diaphragmatic hernia (CDH) every year in the United States. With only a 50 percent survival rate, 800 of those babies will die, according to the Association of Congenital Diaphragmatic Hernia Research, Awareness and Support. Since 2000, more than 720,000 babies have been born with the condition.


CAUSES

According to the National Institute of Health (NIH), diaphragmatic hernia is caused by the improper joining of structures during fetal development. As a result, the abdominal organs such as the stomach, small intestine, spleen, part of the liver, and the kidney appear in the chest cavity. The lung tissue on the affected side is thus not allowed to completely develop. Most affect the left side. Having a parent or sibling with the condition slightly increases your risk.

No one knows how to prevent CDH. The cause of Congenital Diaphragmatic Hernia is still not known but it has been associated with several genetic anomalies such as Fryns Syndrome, Cornelia deLange System, Trisomy 18, 21 and 22, according to the Association of Congenital Diaphragmatic Hernia Research, Awareness and Support. Is has been suggested in some medical journals, but not proven, that thalidomide, quinine, phenmetrazine and nitrofen may cause CDH.

SYMPTOMS

Severe breathing difficulty usually develops shortly after the baby is born, because of ineffective movement of the diaphragm and crowding of the lung tissue, which causes collapse. The reason why this occurs is not known.

Other symptoms include:

• Bluish colored skin due to lack of oxygen
• Rapid breathing (tachypnea)
• Fast heart rate (tachycardia)

The pregnant mother may have excessive amounts of amniotic fluid. Fetal ultrasound may show abdominal contents in the chest cavity.

Examination of the infant shows:

• Irregular chest movements
• Absent breath sounds on affected side
• Bowel sounds heard in the chest
• Abdomen feels less full on examination by touch (palpation)
• A chest x-ray may show abdominal organs in chest cavity.

TREATMENT

A diaphragmatic hernia is an emergency that requires surgery, according to the NIH. Surgery is done to place the abdominal organs into the proper position and repair the opening in the diaphragm.

The infant will need breathing support until he or she recovers from surgery. Some infants are placed on a heart/lung bypass machine, which gives the lungs a chance to recover and expand after surgery.

If a diaphragmatic hernia is diagnosed during pregnancy (around 24 to 28 weeks), fetal surgery may be considered. The outcome of surgery depends on how well your baby's lungs have developed. Usually the outlook is very good for infants who have enough lung tissue. With advances in neonatal and surgical care, survival is now greater than 80 percent, according to the NIH.

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