(Hernia—Diaphragmatic; Congenital Hernia of the Diaphragm)
Diaphragmatic hernia is a congenital defect in which an opening is present in the diaphragm at birth. The diaphragm is the partition separating the chest and abdominal cavities. The abnormal opening allows some of the organs typically found in the abdomen to move into the chest cavity. In infants born with diaphragmatic hernia, the abdominal organs push up against the lungs. This prevents the lungs from developing normally.
Diaphragmatic hernia is a serious condition with many potential complications and side effects.
Diaphragmatic hernia is caused by a failure of the diaphragm to completely fuse during fetal development.
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Risk Factors ^
Factors that may increase the risk of diaphragmatic hernia include:
- Chromosomal syndromes
- Maternal alcohol use
- Pregestational diabetes in the mother
- Severe respiratory distress, including rapid breathing, grunting, use of accessory muscles, and bluish tint to the skin from lack of oxygen
- Asymmetrical or increased diameter of the chest wall
- Concave abdomen
Diagnosis is frequently made on prenatal ultrasound.
If not found prior to birth, a physical exam will be done. A may be done to confirm the presence of abdominal organs in the chest cavity.
Images may be taken of your child's bodily structures. This can be done with achest x-ray.
Treatment includes the following:
Surgery to repair the defect and move the organs into the abdomen may be done. Surgery involves either sewing the edges of the diaphragm together, or if the hole is too large, using an artificial patch to fully close the hole. Fetal surgery may be offered at some institutions.
Aggressive respiratory support, including intubation with mechanical ventilation, is often needed. Different ventilator strategies may be used. Extracorporeal membrane oxygenation (ECMO), or cardiopulmonary bypass, may be necessary.
There are no current guidelines to preent diaphragmatic hernia.
Healthy Children—American Academy of Pediatrics
The American Congress of Obstetricians and Gynecologists
About Kids Health—The Hospital for Sick Children
Congenital diaphragmatic hernia (CDH). Cincinnati Children's website. Available at: http://www.cincinnatichildrens.org/health/c/diaphragmatic-hernias. Updated December 2013. Accessed January 14, 2015.
Congenital diaphragmatic hernia. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated December 2, 2014. Accessed January 14, 2015.
Congenital diaphragmatic hernia. UCSF Benioff Children's Hospital website. Available at: http://fetus.ucsfmedicalcenter.org/cdh. Accessed January 14, 2015.
2/3/2014 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: McAteer JP, Hecht A, De Roos AJ, Goldin AB. Maternal medical and behavioral risk factors for congenital diaphragmatic hernia. J Pediatr Surg. 2014;49(1):34-38.
Last reviewed March 2016 by Marcin Chwistek, MD Last Updated: 5/1/2014