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CDH Treatment |
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Every incidence of CDH is unique in terms of its severity, related anomalies, and other factors. At Children's Hospital Boston, careful management of the pregnancy and delivery, stabilization of the baby, and postnatal treatment have resulted in extremely high success rates.
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Delivery at a hospital that is equipped with extracorporeal membranous oxygenation (ECMO) is important. ECMO is a heart and lung bypass system that does the job that the heart and lungs would be doing: putting oxygen in the bloodstream and pumping blood to the body. ECMO may be used temporarily while a baby's condition stabilizes and improves.
In some cases a procedure called EXIT-ECMO may be warranted. This is a procedure in which the baby is partially delivered via Cesarean section, and a breathing tube is placed to attempt to give the baby oxygen. If the oxygen level of the baby does not rise, he or she is placed immediately on ECMO, then the umbilical cord is cut.
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Treatment may include:
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- Neonatal intensive care - A diaphragmatic hernia is a life-threatening illness and requires care in a neonatal intensive care unit (NICU). Babies with diaphragmatic hernia are often unable to breathe effectively on their own because their lungs are underdeveloped. Most babies will need to be placed on a breathing machine called a mechanical ventilator to help their breathing.
- ECMO - Some infants may need to be placed on this temporary heart/lung bypass system if they have severe problems.
- Surgery - When the baby's condition has improved, the diaphragmatic hernia will be repaired with an operation. The stomach, intestine, and other abdominal organs are moved from the chest cavity back to the abdominal cavity. The hole in the diaphragm is repaired, or if the diaphragm is absent, an artificial diaphragm will be constructed.
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Many babies will need to remain in the NICU for a while after surgery. Although the abdominal organs are now in the right place, the lungs still remain underdeveloped. The baby will usually need to have breathing support for a period of time after the operation. Once the baby no longer needs help from a breathing machine (ventilator), he/she may still need oxygen and medications to help with breathing for weeks, months, or years.
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Specific treatment is determined based on the following:
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- when the problem is diagnosed
- the baby's overall health and medical history
- the severity of the problem
- the baby's tolerance for specific medications, procedures, or therapies
- your opinion or preference.
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Before a baby is discharged from the hospital, certain tests are also to be conducted. These include:
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- Room air arterial blood gas
- EKG
- EEG
- Developmental evaluation
- Head CT scan
- Chest x-ray
- Brain stem auditory evoked potentials
- Ophthalmology evaluation
- Lung ventilation/perfusion scan
- Upper GI study.
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Some of these tests may also be repeated at 6, 12, 24, and 36 months of age.
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The outlook for babies born with CDH is increasingly positive. However, babies born with CDH can have long-term problems and often need regular follow-up after going home from the hospital. Problems may include:
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- Chronic lung disease, requiring oxygen or medications for weeks, months, or years.
- Gastroesophageal reflux, where acids and fluids from the stomach move up to the esophagus (the tube that leads from the throat to the stomach), and can cause heartburn, vomiting, feeding problems, or lung problems. Gastroesophageal reflux can be controlled with medications.
- Difficulties growing, which is known as failure to thrive. Children with the most serious lung problems are most likely to have growing problems. Because of their illness, they often require more calories than a normal baby in order to grow and get healthier. Gastroesophageal reflux can also cause feeding problems, preventing a baby from eating enough to grow.
- Development problems, such as the inability to roll over, sit, crawl, stand, or walk at the same time health babies do. Physical therapy, speech therapy, and occupational therapy are often helpful for these babies to gain muscle strength and coordination. Some babies may have some degree of hearing loss. A hearing test should be performed prior to discharge from the hospital.
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