SERVICES
Congenital diaphragmatic hernia

OVERVIEW

The diaphragm is a vital muscle and thin layer of tissue that separates the chest and abdominal cavities, playing a major role in breathing. When a child has a congenital diaphragmatic hernia (CDH), there is a hole in this layer of muscle and tissue, or in rare cases; the diaphragm is missing entirely. CDH is a condition that affects around one in every 2,500 babies.

In CDH, the contents of the child's abdomen, which could include the stomach, intestines, liver, and/or spleen, may move through the hole and into the chest, interfering with the normal development of the lung on that side and affecting the growth of the other lung. This inadequate lung development makes it difficult for the child to breathe properly after birth.

When abdominal organs interfere with lung growth, it is referred to as pulmonary hypoplasia. Healthy lungs contain millions of small air sacs or alveoli that resemble balloons filled with air. With pulmonary hypoplasia, there are fewer air sacs than normal, and those that are present can only partially fill with air. Additionally, lubricating fluid called surfactant may not work properly, causing the air sacs to deflate easily. As a result, the baby cannot take in enough oxygen to maintain good health.

Symptoms of a congenital diaphragmatic hernia

Newborns with CDH may display the following symptoms:

Irregular breathing
Rapid heartbeat
Cyanosis or blue skin caused by insufficient oxygen
Weak breathing sounds
Presence of bowel sounds in the chest.
A concave abdomen and barrel chest
Abdominal discomfort
Constipation due to bowel obstruction.

Treatment

The treatment for CDH varies based on the individual child's level of severity, related anomalies, and other factors.

During pregnancy, the KZN Specialised Paediatric Surgical Service team will provide careful management of the mother's pregnancy and delivery, as well as postnatal treatment to stabilise the baby. This multidisciplinary care has resulted in high success rates.

At delivery, our surgical team is present to assist the obstetrician and immediately begin to care for your child. Your baby will require a breathing tube and mechanical ventilator. If the baby's heart and lungs cannot support their condition, extracorporeal membrane oxygenation (ECMO) may be required.

After birth, your baby will be cared for in our Medical-Surgical Intensive Care Unit (MSICU) at KZN Specialised Paediatric Surgical Service Centre. They will remain on the mechanical ventilator and undergo head ultrasounds and echocardiograms to assess their condition. Once their condition improves, our paediatric surgeons will perform an open or thoracoscopic operation to repair the diaphragmatic hernia by moving the abdominal organs back to their proper position and closing the hole in the diaphragm with stitches or a patch.

REQUEST A CONSULTATION

Dr Mangray, the founder of KZN Specialised Paediatric Surgical Service, and his associates, Dr Ngobese, Dr Govender and Dr Dube-Zvirikuzhe, have a well-established reputation for caring for children right until late adolescence.

FREQUENTLY ASKED QUESTIONS

FAQ

1What is the long-term outlook for babies with congenital diaphragmatic hernia?

The long-term outlook for babies with congenital diaphragmatic hernia can vary depending on the severity of their condition and any associated health problems. However, with timely and appropriate treatment, many babies with CDH are able to live healthy and fulfilling lives.

2How is a congenital diaphragmatic hernia diagnosed?

Congenital diaphragmatic hernia can often be detected during pregnancy through an ultrasound. After birth, imaging tests such as X-rays or echocardiograms can confirm the diagnosis.

3 How can ECMO help?

Extracorporeal membrane oxygenation (ECMO) may be necessary if the baby's heart and lungs are unable to support their condition, but this is an intervention not offered at our centre.