What is Congenital Diaphragmatic Hernia
The Congenital Diaphragmatic Hernia is simply a birth defect that occurs in babies. Before understanding this type of hernia, we need to understand what is a diaphragm.
There is a wide, flat muscle that separates the chest cavity from the abdominal cavity which is known as the diaphragm. Usually, the diaphragm forms when a baby is 8 weeks old inside the mother’s womb.
Sometimes, the diaphragm does not form completely, creating a hole in the muscle through which other developing abdominal organs (such as intestines, stomach, and liver) can protrude that can affect the development of lungs. This protrusion is known as a congenital diaphragmatic hernia (CDH).
According to available literature, the incidence of CDH ranges from 5 per 10,000 births and varies across the population.
This condition could be one of the reasons that a baby is unable to breathe properly after birth. Hence, it is considered as a serious ailment for babies.
Let’s dig a little deeper to understand this complicated condition. Healthy lungs are made of millions of balloon-like structures known as the alveoli. When the other organs pushed through the hole prevents the lungs from growing, it affects in three ways-
- The number of air sacs reduces
- The already existing number of air sacs doesn’t get filled completely
- The existing air sacs deflate easily
When any one of the above scenarios occurs, the baby is unable to breathe in oxygen properly.
There are two types of Congenital Diaphragmatic Hernia that can occur in babies-
- Bochdalek hernia- This occurs in ninety percent of children in which there is a hole in the back of the diaphragm.
- Morgagni hernia- In this type of hernia, there is a hole in the front of the diaphragm.
Causes and Risk factors of Congenital Diaphragmatic Hernia
There are a lot of speculations over the factors that can contribute to the development of this type of hernia. Although studies conducted to determine the causes and the associated risk factors of CDH have highlighted that multiple genes from both the parents and other environmental factors can increase the chances.
Some environmental factors that scientists believe increase the risk are-
- Result of a blunt or penetrating injury
- Previously failed surgeries in the abdomen or chest
Symptoms of Congenital Diaphragmatic Hernia
Doctors lookout for the following symptoms to check if the baby has a congenital diaphragmatic hernia-
- Difficulty in breathing
- The pace of breathing is fast
- Heart rate is very fast
- The skin color turns blue
- One side of the chest seems larger than the other side
- Abdomen looks caved in
Complications of Congenital Diaphragmatic Hernia
The condition of diaphragmatic hernia can turn out to be fatal for a baby. The reason is that the baby is unable to take in enough oxygen to stay healthy.
This can lead to not only abnormal development of lungs but also the digestive system and the heart. They can even develop symptoms of another birth defect.
Commonly associated complications of diaphragmatic hernia include-
Diagnosis of Congenital Diaphragmatic Hernia
The diagnosis of CDH is already made when the fetus is growing inside the mother’s womb. Babies with the hernia are identified during the ultrasound sessions.
The gynecologist looks at the ultrasound and sees if the baby’s organs are at the right place or not. They also look out for the condition of the heart and lungs of the growing baby.
In some cases, the condition is diagnosed only after the baby is born. Just after birth, if the baby has difficulty breathing, a chest X-Ray is done to check out the lungs. The X-Ray also allows the doctors to see the stomach, intestine or chest area.
If required, blood tests are also recommended to check for genetic analysis. The heart rate, blood pressure, respiratory rate is also continuously monitored.
Treatment of Congenital Diaphragmatic Hernia
As this is a life-threatening condition, there is no time to spare. The following treatment is administered without further delay-
- Ventilation- In order to help the baby breathe, it is put on a mechanical ventilator. This provides the baby with the required oxygen to let the body function.
- Oxygenation- A bypass machine, directly pumps oxygen into the bloodstream of the baby that flows throughout the body.
- Surgery- Once the baby is able to breathe properly, the doctor repairs the hernia with a surgery in which the organs are put back to its original position and then closes the hole.
Will the Congenital Diaphragmatic Hernia create problems in the future?
Even after proper treatment of the hernia, babies born with CDH need regular follow up care once they go back from the hospital.
There are very high chances that the baby continues to have problems in the lungs that require continuous breathing support, oxygen, and medications that help them to breathe in the future.
The problem of gastroesophageal reflux disease (GERD) that has developed before may continue to be a problem even after the surgery. As the acid and fluids move up the food pipe, there can be symptoms of heartburn, vomiting, or difficulty in feeding.
Can Congenital Diaphragmatic Hernia be prevented?
The answer to the question every parent asks after their baby is diagnosed with this condition is a disappointing NO. It can only be detected before birth with early and regular prenatal care. This helps the parents to prepare better after the delivery.