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Congenital Diaphragmatic Hernia
Congenital Diaphragmatic Hernia (CDH) is a birth defect where the diaphragm fails to close properly during the 8-9th week of gestation. As a result of this failure to close, organs from the abdominal cavity are able to migrate and grow in the chest cavity thus preventing the lungs from fully developing. Some of the organs that are found in the chest include the stomach, intestines, liver, spleen, gall bladder, as well as occasionally even the kidneys and other organs. This can often be seen with an ultrasound, though not all babies are diagnosed before birth.
Since the lungs fail to form properly, when the child is born they normally need immediate ventilation. The surgeon will, when in his or her opinion the child is stable enough, repair the hole in the diaphragm and place the abdominal organs back in the cavity where they belong. The hole can be fixed with a stitch or two, a patch made from a variety of materials including goretex or marlex, or it can even be repaired with muscle tissue from the abdomen of the child. The choice of repair depends greatly on how severe the defect is. Sometimes there is even a complete absence of part or even all of the rim of the diaphragm.
The survival of CDH babies depends on a variety of factors: the size of the defect, which organs had moved into the chest, whether polyhydramnios was present, as well as whether the defect was known before birth so that the delivery could be performed at a specialized hospital.
Children with CDH have a variety of other problems that the families must deal with as well. Most have eating problems, a great number must be tube fed with a gastrostomy tube. Some have additional intestinal problems such as reflux and need a fundoplication. Occasionally there is severe intestinal malrotation that requires straigtening or even removal of part of the intestinal tract. Other problems such as scoliosis, hearing or vision trouble and cerebral palsy may also be a part of CDH or result from the treatment of it.
Currently, statistics show that CDH is present in one in every 2,500 to 3,000 births. There is no known cause at this time, though it is thought it could be caused from a variety of exposures to pesticides or other chemicals, as well as possible genetic links in families with multiple children born with it.
For further information, as well as a fantastic support group for CDH families, please go to CHERUBS.
Home, Seans (long) story, Short Bowel Syndrome,
Gastrostomy, Fundoplication, TPN, Other Links
