If you are a mother-to-be or expecting a new member to join your family, this story will be very important to you. Sometimes our little ones can come into this world with birth defects that we have never even heard of. That is one of those situations that we are going to talk about today, a bit complicated, but very worth being aware of.
What is CDH? Let's understand it simply.
Okay, now let's see what this `(Congenital Diaphragmatic Hernia)` or `(CDH)` is for short. Simply put, this is a condition that occurs at birth. This happens while the baby is still in the womb. There is a muscle that separates our chest and abdomen, which we call the `Diaphragm` . It is like a wall that separates two rooms. If this diaphragm is not strong enough, or if there is a hole in it, the organs in the abdomen – that is, the stomach, intestines, liver, etc. – can enter the chest cavity. That is what we call a `(Hernia)`, or a hernia.
Now imagine what would happen if something like this happened while the baby was growing in the womb. When the organs in the abdomen move into the chest, there is not enough room there, right? The main problem is that the lungs do not have enough room to grow properly. When the lungs are small, that is, when a condition called `(Pulmonary Hypoplasia)` occurs, the baby has difficulty breathing after birth, and the blood does not get enough oxygen. Not only that, but the blood pressure in the lungs can also increase. This also puts a lot of pressure on the heart. Therefore, a baby with `(CDH)` needs specialized medical treatment right after birth.
What are the symptoms of a baby with CDH?
If your baby has severe difficulty breathing right after birth, it could be a major sign of the condition (CDH). In addition, you may also see things like:
- A very fast heartbeat (Tachycardia).
- Cyanosis is the bluish discoloration of the skin due to lack of oxygen.
- Very low breathing sounds (especially on one side).
- Hearing the sound of the intestines when you put your ear to the chest.
- The chest bulges out and looks like a barrel, while the stomach seems to be sinking in.
If your baby has one or more of these symptoms, it's best to see a doctor immediately.
Why does this CDH develop? What are the causes?
It's actually difficult for doctors to say exactly what the exact cause of this ``(CDH)`` condition is. However, research has found that the following factors may be involved:
- Genetic factors: That is, certain things that are passed down through generations.
- Exposure to harmful substances during pregnancy: Things like certain chemicals and cigarettes.
- Inadequate nutrition for the fetus: The baby gets its nutrition from the food the mother eats.
These are the current reasons, but further research is being done on this.
What complications can occur due to CDH?
As we've discussed before, many babies with CDH have underdeveloped lungs (Pulmonary Hypoplasia). This can cause a variety of problems:
- Low oxygen levels in the blood (Hypoxemia): This affects all of the baby's organs, especially the brain and heart. If this condition is severe or persistent, it can cause long-term damage.
- High blood pressure in the arteries of the lungs (Pulmonary Hypertension): This puts a lot of strain on the right side of the heart and can even cause heart failure.
- Lung Infections: Improperly developed lungs can easily develop infections such as pneumonia. Even after a hernia is repaired with surgery, the risk of these infections can persist throughout life.
In addition to this, babies with `(CDH)` are likely to have other problems:
- Feeding difficulties: This can be due to pressure on the abdominal organs or due to multiple medical interventions during birth. Some babies may need to be tube fed for a long time, and may also experience growth faltering.
- Developmental Delays: Some babies may need physical, speech or occupational therapy for a period of time due to lack of oxygen.
- Sensorineural Hearing Loss: Some babies with CDH gradually lose their hearing. Scientists are not yet sure whether this is caused by the condition itself, the treatment, or both.
Imagine how much a burden a mother or father must feel when hearing something like this. But remember, medical science is very advanced now.
How do doctors diagnose CDH?
Most of the time, doctors can detect this condition during a routine prenatal ultrasound scan during your pregnancy. Once detected, they will perform further tests. For example, they will perform a fetal MRI to look at the hernia more clearly. They will also perform a fetal echocardiogram to see if the fetus's heart has been affected.
Sometimes, doctors may not notice CDH until after the baby is born. After the baby is born, the medical team may suspect it if they notice things like difficulty breathing, a deviated septum, or a bulging chest. They will then do a chest X-ray and an echocardiogram . They may also take a blood sample to check the baby's blood oxygen levels and to check for other genetic abnormalities .
Very rarely, babies with CDH may not show any major symptoms at birth. If the hernia is very small, it may not be detected during childhood, or even into adulthood.
What are the treatments for CDH?
Treatment for this condition, ``Congenital Diaphragmatic Hernia'', begins as soon as it is diagnosed. You may feel scared when you hear about this treatment, but remember that doctors are doing everything to protect your baby.
Prenatal treatment
If you are diagnosed with CDH during your pregnancy, your doctor will monitor you closely. They will check for problems with other organ systems, as it can sometimes be part of a more complex condition. They will also check to see if your baby is going to be born prematurely (premature labor), and if so, they will decide whether to induce labor (induce labor) to help the baby's health.
In some special cases, the medical team can treat the fetus before the baby is born. ``Fetoscopic Tracheal Occlusion (FETO)`` is one such fetal surgery. It helps to improve the size and function of the fetus's lungs as the baby grows in the womb. This is done using a small camera called ``Fetoscopy``, through small incisions made through your skin into your uterus.
In this `(FETO)` procedure, the doctor inserts a small balloon into the `(Trachea)` of the fetus. Then, the `(Amniotic Fluid)` that the baby swallows collects behind the balloon and inside the lungs, causing the lungs to inflate. This inflating improves the growth and function of the lungs, and helps to correct some of the damage caused by `(CDH)`.
Neonatal treatment
Babies born with CDH usually need intensive care from a specialist team right after birth. If the baby's lungs are not fully developed (Pulmonary Hypoplasia), they will first be given oxygen support. For some babies, this may be a breathing tube connected to a mechanical ventilator .
Some babies may need even more intensive life support. This is called Extracorporeal Membrane Oxygenation (ECMO) . This involves bypassing the baby's immature lungs and sometimes the heart, and using a machine to add oxygen to the blood and return it to the baby's body.
Next, the baby will need surgery. The baby will be kept in the Neonatal Intensive Care Unit (NICU) until the baby is stable enough for surgery. This usually means until the high blood pressure in the lungs (pulmonary hypertension) has subsided and the extracorporeal membrane oxygenation (ECMO) is no longer needed.
For the surgery, a pediatric anesthesiologist will put the baby to sleep under anesthesia . Then a pediatric surgeon will perform the surgery, returning the organs that were in the chest to the abdomen and repairing the defect in the diaphragm. In most cases, which is about half of all surgeries, doctors are able to perform a minimally invasive surgery (MIS) that involves making small incisions of about 3 millimeters instead of a large incision .
What is the recovery time like?
As your baby recovers from surgery, you will gradually be weaned off oxygen. You will continue to be fed through a tube until the breathing tube is removed. After that, speech therapists and lactation specialists will help you and your baby start feeding by mouth. Some babies take longer to wean off oxygen and tube feeding than others. Your medical team will support you as long as necessary.
What is the future of babies with CDH?
The good news is that the survival rate for babies born with CDH has improved dramatically. Between 7 and 9 out of 10 babies survive. Although these babies are born with very serious conditions, if they get through the first few days, their chances of survival are much better. Some children may have long-term complications, but they can also live long, full lives. With advances in medical science, short-term survival rates and long-term health outcomes are improving day by day.
The long-term prognosis depends on several factors:
- Was the baby born prematurely?
- How bad the baby's condition was at birth.
- The size of the hernia.
- What organ has gone into the chest?
- Are there any other health problems?
Babies who need breathing or feeding assistance for a long time are at higher risk of developing ongoing complications, such as chronic lung disease, growth failure, hearing loss, and developmental delays. Your child's doctor will monitor them closely throughout their early years.
Finding out that your baby has a congenital diaphragmatic hernia can be very scary and overwhelming. Your baby will be taken to the intensive care unit (ICU) right after birth, and may even have to stay in the hospital for a long time. But with advances in medical science, the outlook for the condition is better than ever. Even though this is a difficult time, there is a team of doctors and nurses here to help you and your newborn. They will support you from the moment of diagnosis, throughout your baby's early life.
Things we need to remember
Although this condition called `(Congenital Diaphragmatic Hernia - CDH)` is a bit serious, if you are aware of it in advance, you can face it without panicking.
- CDH is a condition that occurs at birth and causes the organs in the abdomen to move into the chest due to a defect in the diaphragm.
- This mainly affects the development of the lungs.
- This can be detected through scans during pregnancy.
- They require specialized treatment and surgery immediately after birth.
- With advances in medical science, most of these babies can live good lives.
If you have any more questions or concerns about this, be sure to talk to your doctor or nurse. They can give you more information and help you take the stress off your mind. Remember, you are not alone.
` CDH, Congenital Diaphragmatic Hernia, Diaphragmatic hernia, Birth defects, Lung development, Baby health, Surgery
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