Presented by: Myrna Macias and Amanda Aldrete

Identify the maternal, fetal and Identify the maternal, fetal and neonatal risk factors which neonatal risk factors which predispose an infant to CDH. predispose an infant to CDH.

Describe the clinical Describe the clinical presentation of CDH.presentation of CDH.

Identify radiologic changes in Identify radiologic changes in the course of CDH. the course of CDH.

Identify complications Identify complications associated with CDH. associated with CDH.

Discuss the management of an Discuss the management of an infant with CDH. infant with CDH.

Which means, Which means, “present at birth“present at birth”. It ”. It simply means that a defect has been simply means that a defect has been

present since the time of birth.present since the time of birth.

• A congenital A congenital diaphragmatic diaphragmatic hernia is a birth hernia is a birth defect where there defect where there is an abnormal hole is an abnormal hole in the diaphragm. in the diaphragm.

TYPES OF CDHTYPES OF CDH

Morgagni HerniaMorgagni Hernia – which – which

involves an opening on the involves an opening on the right right sideside of the chest. of the chest.

There is 2 types of Congenital Diaphragmatic Hernias.There is 2 types of Congenital Diaphragmatic Hernias.

Bochdalek HerniaBochdalek Hernia - which - which involves an opening on the involves an opening on the left left sideside of the chest. of the chest.

BOCHDALEK HERNIABOCHDALEK HERNIA

• Most common type of Most common type of hernia (left sided hernia)hernia (left sided hernia)

• Makes up 90% of all Makes up 90% of all casescases

• Slightly more common in Slightly more common in boysboys

• Shifting the of the heart Shifting the of the heart and the mediastinal to and the mediastinal to the left, causing cardiac the left, causing cardiac compression compression

• Uncommon type of Uncommon type of hernia (right)hernia (right)

• Makes up 2% of all Makes up 2% of all casescases

• More common in More common in girlsgirls

• Signs and symptoms Signs and symptoms may or may not be may or may not be present present

Bochdalek herniaBochdalek hernia

Morgagni Morgagni HerniaHernia

• Intestinal problems• Hypoplastic lungs • Pulmonary

hypertension• Decreased cardiac

output• Cyanosis

• Inherited genetically from the parents.Inherited genetically from the parents.• Result of damage or infection in the uterus, Result of damage or infection in the uterus,

or may have occurred at time of birth. or may have occurred at time of birth. • Most commonly seen on the Most commonly seen on the left side of the left side of the

bodybody but may also occur on the right side or but may also occur on the right side or the central portion of the diaphragm. the central portion of the diaphragm.

Present at birth:Rapid and shallow breathing Tachycardia (>180 bpm)Cyanosis Paradoxical breathingBreath sounds absent on the affected

side. Bowel sounds heard in the chest. Concave abdomen that feels less full

when touched.

• 12-15% of babies with CDH have other 12-15% of babies with CDH have other abnormalities such as hypoplastic heart or abnormalities such as hypoplastic heart or ventricular septal defectventricular septal defect

• Rate of about one in Rate of about one in every 2,500 births.every 2,500 births.

• The left-sided Bochdalek The left-sided Bochdalek hernia is seen in hernia is seen in approximately 90% of approximately 90% of cases. cases.

• The Morgagni hernia, a The Morgagni hernia, a less-common, occurring less-common, occurring in only 5-10% of cases of in only 5-10% of cases of CDH. CDH.

• Made before birth by ultrasound of the fetusMade before birth by ultrasound of the fetus• Excess amounts of amniotic fluidExcess amounts of amniotic fluid• Other tests such as fetal MRI, chromosome Other tests such as fetal MRI, chromosome

studies and fetal echocardiogram may also studies and fetal echocardiogram may also be donebe done

• Liver positionLiver position• Liver-to-head ratio Liver-to-head ratio

(LHR)(LHR)

• Liver down = Larger lungLiver down = Larger lung• LHR estimates size of lungsLHR estimates size of lungs• LHR LHR >> 1.4 1.4 • Good chance of survivalGood chance of survival• LHR LHR << 1.0 1.0 • Difficult time with survivalDifficult time with survival

• At the Fetal Treatment Center at the At the Fetal Treatment Center at the University of California in San Francisco University of California in San Francisco advances have been made that allow new advances have been made that allow new medical treatments for CDH.medical treatments for CDH.

• This new treatment is very different than conventional treatments in one way. It is completed while the baby is still in the mother’s uterus.

• FETENDOFETENDO• HFOVHFOV• NONO• ECMOECMO

• Congenital Diaphragmatic HerniaCongenital Diaphragmatic Hernia. Retrieved May 20, 2008, from . Retrieved May 20, 2008, from http://www.chw.org/display/PPF/DocID/34373/Nav/1/router.asphttp://www.chw.org/display/PPF/DocID/34373/Nav/1/router.asp

• Congenital Diaphragmatic HerniaCongenital Diaphragmatic Hernia. (2008, May 2). Retrieved May 20, . (2008, May 2). Retrieved May 20, 2008, from http://fetus.ucsfmedicalcenter.org/cdh/2008, from http://fetus.ucsfmedicalcenter.org/cdh/

• Congenital Diaphragmatic Hernia (CDH)Congenital Diaphragmatic Hernia (CDH). Retrieved May 14, 2008, . Retrieved May 14, 2008, from http://www.chop.edu/consumer/jsp/division/generic.jsp?from http://www.chop.edu/consumer/jsp/division/generic.jsp?id=86686id=86686

• Congenital Diaphragmatic HerniaCongenital Diaphragmatic Hernia. Retrieved May 14, 2008, from . Retrieved May 14, 2008, from http://www.eapsa.org/parents/resources/diaphjramaticHernia.cfmhttp://www.eapsa.org/parents/resources/diaphjramaticHernia.cfm

• Diaphragmatic herniaDiaphragmatic hernia. (2007, July 26). Retrieved May 14, 2008, from . (2007, July 26). Retrieved May 14, 2008, from http:/www.nlm.nih.gov/medlineplus/ency/article/001135.htmlhttp:/www.nlm.nih.gov/medlineplus/ency/article/001135.html

• 20/20, ABC, News. 20/20, ABC, News. The Analisa Amen StoryThe Analisa Amen Story. (2008, April 1). Retrieved . (2008, April 1). Retrieved May 23, 2008, from May 23, 2008, from http://fetus.ucsfmedicalcenter.org/cdh/analisa_amen.asphttp://fetus.ucsfmedicalcenter.org/cdh/analisa_amen.asp

• Hovsepian M.D., Michael , ., , Sheila, Berlin M.D.., Morrison M.D., Hovsepian M.D., Michael , ., , Sheila, Berlin M.D.., Morrison M.D., Stuart, ., Meyers M.D., Melissa, ., Sivit M.D., Carlos, ., Weinert M.D., Stuart, ., Meyers M.D., Melissa, ., Sivit M.D., Carlos, ., Weinert M.D., Dana, ., , Rainbow Babies, ., , Children's Hospital, . Dana, ., , Rainbow Babies, ., , Children's Hospital, . Case Fourteen-Case Fourteen-Congenital Diaphragmatic HerniaCongenital Diaphragmatic Hernia. Retrieved May 20, 2008, from . Retrieved May 20, 2008, from http://www.uhrad.com/pedsarc/peds014.htmlhttp://www.uhrad.com/pedsarc/peds014.html