To understand congenital diaphragmatic hernia and how a diaphragm defect can affect a baby’s breathing, we spoke with Dr Prashant Jain, Principal Director & Head, Paediatric Superspecialities, Paediatric Surgery, BLK-Max Hospital.
What Is Congenital Diaphragmatic Hernia?
The diaphragm is a thin, dome-shaped muscle located below the lungs. It moves with each breath, helping the lungs draw air into the body.In a congenital diaphragmatic hernia, a hole or weak area forms in this muscle. Through this opening, organs such as the stomach, intestines, spleen, or liver may move into the chest.
The most common type is called a Bochdalek hernia, which usually occurs on the left side. A less common type, Morgagni hernia, occurs toward the front of the diaphragm.
How Does CDH Affect a Babys Breathing?
A baby's lungs develop throughout pregnancy. When abdominal organs move into the chest, they can limit lung growth and cause pulmonary hypoplasia, where the lungs are smaller and less developed.After birth, the baby may have difficulty getting enough oxygen. Narrow blood vessels in the lungs can also cause pulmonary hypertension, making breathing and oxygen exchange more difficult.
What Causes Congenital Diaphragmatic Hernia?
In many babies, the exact cause of CDH is not known. It develops as the diaphragm forms during early pregnancy.Some cases may occur as part of a genetic condition or alongside other birth defects. These can involve the heart, kidneys, brain, limbs, or chromosomes.
Importantly, parents should not assume that something they ate, did, or failed to do during pregnancy caused CDH. In most cases, no clear action could have prevented the defect.
Can CDH Be Detected During Pregnancy?
Yes. CDH is sometimes identified during a routine prenatal ultrasound.The scan may show:
- Abdominal organs in the chest
- An unusual position of the heart
- Changes in the size and appearance of the lungs
In selected cases, an MRI may also be used to provide additional information about the baby's lungs and the position of abdominal organs.
What Symptoms Can a Baby Have After Birth?
Possible signs include:- Rapid or difficult breathing
- Low oxygen levels
- Bluish or greyish skin
- A fast heart rate
- A sunken-looking abdomen
- Reduced breath sounds on one side of the chest
- The heart appearing displaced from its usual position
How Is CDH Treated?
Treatment depends on the baby's condition and may include:1. Breathing Support
- A ventilator may help the baby breathe and maintain oxygen levels
- Gentle ventilation is used to protect the underdeveloped lungs
- Severe cases may need ECMO for temporary heart and lung support
- Surgery closes the opening in the diaphragm
- Abdominal organs are returned to the abdomen
- Surgery is usually performed once the baby's condition is stable
- A patch may be needed for a larger diaphragm defect
- Medicines may help manage blood pressure and other problems
- Fluids and nutrition are provided as needed
- Oxygen levels, blood pressure, and heart function are closely monitored
- Treatment is adjusted as the baby gradually stabilises
Congenital Diaphragmatic Hernia is fundamentally a race against pulmonary compromise. The surgical objective extends beyond returning viscera to the abdomen. The cornerstone of care lies in stabilising respiratory mechanics and pulmonary pressures before reconstructing the diaphragmatic wall.
What Can Parents Expect After Treatment?
Recovery from CDH is different for every baby. Some children have relatively few long-term problems, while others need ongoing medical follow-up.Possible longer-term concerns may include:
- Breathing difficulties
- Feeding problems
- Acid reflux
- Slower growth
- Hearing problems
- Developmental delays
- Recurrent respiratory infections
- Reduced exercise tolerance
When Should Parents Seek Medical Advice?
If your baby has suspected or confirmed CDH, timely medical care is important:- Discuss the diagnosis with a maternal-fetal medicine specialist
- Plan newborn care with an experienced neonatal team
- After birth, the baby needs immediate medical assessment
- Seek urgent care for breathing difficulty or low oxygen levels
FAQs on Congenital Diaphragmatic Hernia in Babies: How It Affects Breathing and Treatment
- Is congenital diaphragmatic hernia life-threatening?
CDH can be serious because underdeveloped lungs and abnormal lung pressure may affect oxygen levels. The severity depends on lung development and whether other health problems are present. - Can a baby with CDH breathe normally after surgery?
Surgery repairs the diaphragm but does not immediately increase lung size. Breathing may gradually improve as the lungs and circulation recover, although some babies need prolonged respiratory support. - Does CDH always require surgery?
Most significant cases require surgical repair. However, doctors usually stabilise the baby's breathing and circulation before operating, often immediately after birth.
