Introduction:
Congenital diaphragmatic hernia is a birth defect in which there is hole in a portion of diaphragm causing abdominal organs to go up in the thoracic cavity.This causes lung compression & respiratory distress in a newborn.
Incidence:
1 : 2000-5000 live birth
8 % of all major congenital anomalies
The cause of CDH is largely unknown
1 : 2000-5000 live birth
8 % of all major congenital anomalies
The cause of CDH is largely unknown
Prenatal Diagnosis:
Fetal USG shows stomach, intestines, liver, kidneys & spleen in the chest cavity
Abnormal position of certain viscera inside the abdomen
Stomach visualization out of its usual position
Intrauterine growth retardation
Polyhydramnios, Fetal hydrops
Abnormal position of certain viscera inside the abdomen
Stomach visualization out of its usual position
Intrauterine growth retardation
Polyhydramnios, Fetal hydrops
Clinical Presentation:
The newborn presents with severe respiratory distress
On examination:
Respiratory distress
Scaphoid abdomen
Auscultation of the lungs reveals poor air entry
Shift of the heart to the side opposite
Scaphoid abdomen
Auscultation of the lungs reveals poor air entry
Shift of the heart to the side opposite
Diagnosis:
Plain X-ray abdomen (erect) - shows the bowel loops in the thoracic cavity with compression of ipsilateral lung.
Ultrasonography of chest - will confirm the presence of the bowel & other viscera
2-D echo & Renal USG- To rule out associated cardiac & renal anomalies.
Management:
Mechanical ventilation
Nitric Oxide
Surfactant
ECMO
Surgery
Nitric Oxide
Surfactant
ECMO
Surgery
Surgical management: By abdominal or thoracic approach the intestinal contents are placed in the abdomen & the hole in the diaphragm is sutured.
