Congenital Diaphragmatic Hernia (CDH)Prenatal

Background

Anatomy

What happens with diaphragmatic hernia?

Abdominal organs move into the chest, preventing the lungs from growing

Diaphragmatic hernia anatomy

What can you expect now?

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Prenatal ultrasounds

Delivery Planning

Care after birth

Breathing tube

Transfer to Seattle Children’s

Supportive care in the Newborn Intensive Care Unit - NICU

standard ventilators jet ventilators inhaled nitric oxide

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ECMO (Extra Corporeal Membrane Oxygenation)

ECMO (Extra Corporeal Membrane Oxygenation)

Surgery

Repair of diaphragmatic hernia

Intestine and/or organs are pulled back down into the abdomen

Repair of diaphragmatic hernia

Hole in diaphragm

Repaired diaphragm

X-rays before & after surgery

What to expect after surgery

• Gradually wean off support of heart and lungs

• Transfer out of NICU when off the ventilator and requiring less oxygen

What about eating?

• GERD

• Feeding advancement and therapy

Who is on the baby’s care team?

• Board Certified pediatric surgeons• Neonatologists• Pediatric surgical fellows and residents• Nurse practitioners• Dieticians• Pharmacists• Pediatric heart and lung specialists

Discharge home

When can the baby go home?

• Criteria for discharge

• Typical care and supplies at discharge

• Variable length of hospital stay

Care after discharge

Surgery - Pulmonary Follow-up Clinic

Dr. Thida Ong

After Surgery

• Lung growth and function

• Intestinal obstruction

• Hernia recurrence

Outcomes

• 80-90% survival for CDH at Seattle Children’s

• Lower survival (50%) for babies who need ECMO

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Questions?