Parents, diaphragmatic hernia is a birth defect that makes it difficult for a baby to breathe. This condition can develop while the baby is still in the womb, and should be treated immediately if diagnosed.
Because this condition can be dangerous for your little one, you should know the symptoms, causes, treatment, and prevention below.
What is a Diaphragmatic Hernia?
Quoting from the Centers for Disease Control and Prevention (CDC) , congenital Diaphragmatic Hernia (CDH) or diaphragmatic hernia is a birth defect in which there is a hole in the diaphragm (the large muscle that separates the chest from the abdomen).
When these gaps form during fetal development in the womb, the intestines, stomach, or even the liver can move into the chest cavity.
Organs that migrate to the chest will eventually result in respiratory complications. Because this condition forces the lungs to grow in a compressed state, some aspects of their function may not develop normally until after the baby is born.
That is why a diaphragmatic hernia can prevent a baby’s lungs from fully developing, causing breathing difficulties for the baby at birth. A diaphragmatic hernia can trigger life-threatening problems, so this condition needs to be treated immediately.
There are two most common types of diaphragmatic hernia , namely:
- Bochdalek hernia. This involves the sides and back of the diaphragm. The stomach, liver, spleen, or intestines rise into the baby’s chest cavity.
- Morgagni hernia. This involves the front of the diaphragm. The liver or intestines rise into the baby’s chest cavity.
Symptom
The severity of symptoms with a diaphragmatic hernia can vary depending on the size, cause, and organs involved. Also, symptoms can occur slightly differently in each child.
In Bochdalek diaphragmatic hernia symptoms appear soon after your baby is born. Common symptoms that may be seen are:
1. Difficulty Breathing
This is usually very severe. In CDH, it is the result of abnormal development of the lungs. In acquired diaphragmatic hernia (ADH), it occurs when the lungs cannot function properly due to tightness.
2. Tachypnea (Rapid Breathing)
The baby’s lungs may try to compensate for the low oxygen levels in the baby’s body by breathing more rapidly.
3. Skin Color Changes to Blue
When the body doesn’t receive enough oxygen from the lungs, it can make a baby’s skin appear blue (cyanosis).
4. Tachycardia (Fast Heartbeat)
Your baby’s heart may pump faster than usual to try to supply your body with oxygenated blood.
5. Reduced or Absent Breath Sounds
This symptom is common in CDH because one of the baby’s lungs may not have formed properly. Breath sounds on the affected side will be absent or very difficult to hear.
6. Bowel Sounds in Chest Area
This occurs when the baby’s intestines rise into the chest cavity.
7. Stomach looks sunken or scaphoid
The baby’s abdomen may feel less full than it should on palpation (examination of the body by pressing on certain areas). This is because the abdominal organs are being pushed up into the chest cavity.
Babies born with a Morgagni hernia may not have any symptoms. Symptoms of this condition may be similar to those of other health problems. Be sure to have your little one see a healthcare provider for a diagnosis.
Causes of Diaphragmatic Hernia
Congenital diaphragmatic hernia (CDH) is caused by abnormal development of the diaphragm as the fetus forms, at 10 weeks of gestation.
A defect in the fetus’ diaphragm allows one or more of their abdominal organs to move into the chest and take up space where the lungs should be. As a result, the lungs cannot develop properly. In most cases, this only affects one lung.
Sometimes CDH is caused by a problem with the baby’s chromosomes or a genetic abnormality. If this is the case, the baby may have additional medical problems or organ abnormalities.
In other cases, CDH may occur without an identifiable genetic cause. This is called isolated CDH, and in this situation the primary concern is the degree of pulmonary hypoplasia caused by the defect.
This condition is usually the result of a blunt or penetrating injury. Traffic accidents and falls cause the majority of blunt injuries.
Surgery on the abdomen or chest can also cause inadvertent damage to the diaphragm. In rare cases, a diaphragmatic hernia can occur for no known reason and go undiagnosed for a period of time, until it becomes severe enough to cause symptoms.
How Often Does It Happen?
Researchers estimate that about 1 in every 3,600 babies is born with a diaphragmatic hernia in the United States. About half of all newborns with a diaphragmatic hernia also have other conditions, including birth defects of the brain, heart, and intestines.
However, in Indonesia itself, there is no data on how many cases of babies experience this condition.
Risk Factors
Most congenital diaphragmatic hernias are idiopathic; their cause is unknown. It is believed that a combination of factors leads to their development.
Chromosomal and genetic abnormalities, environmental exposures and nutritional problems may all play a role in the formation of these hernias. It can also occur with other organ problems such as abnormal development of the heart, gastrointestinal or genitourinary system.
The following factors may increase the risk of another diaphragmatic hernia:
- blunt injury due to traffic accident
- surgical procedures on the chest or abdomen
- fall that impacts the diaphragm area
- stab wound
- gunshot wound
Diagnosis
During pregnancy, there are screening tests to check for certain birth defects and other conditions. Doctors can usually diagnose a diaphragmatic hernia before the baby is born. Usually, doctors use an ultrasound to create images of the diaphragm and lungs to look for abnormalities.
In some cases, an ultrasound during pregnancy does not show a diaphragmatic hernia. There may also be an increase in the amount of amniotic fluid (the fluid that surrounds and protects the fetus) in the uterus.
Then after the baby is born, the following abnormalities may appear during a physical examination:
- abnormal chest movement
- difficulty breathing
- blue discoloration of the skin (cyanosis)
- no breath sounds on one side of the chest
- bowel sounds in chest
- Stomach feeling “half empty”
The following tests are usually sufficient to diagnose CDH or ADH:
- X-ray
- ultrasound scan (uses sound waves to produce images of the chest and abdominal cavities and their contents)
- CT scan (allows direct viewing of abdominal organs)
- arterial blood gas test (taking blood directly from an artery and testing the levels of oxygen, carbon dioxide, and acidity, or pH levels)
- MRI (for more focused organ evaluation especially in the fetus)
Handling and Care
After birth, babies with CDH can undergo surgery to close the defect. However, postnatal surgery does not address the lung damage that has already occurred.
For this reason, fetal therapy procedures are recommended in some pregnancies. These procedures can help reduce the amount of lung damage that can occur during pregnancy.
The goal of fetal treatment is to reverse some of the lung damage caused by lung compression.
Fetal Care for CDH
1. Fetoscopic tracheal occlusion (FETO)
The fetal lungs produce fluid that exits the body through the baby’s mouth. If this fluid outflow is blocked, it has nowhere to go and swells up in the affected lung.
When this occurs over four to five weeks, the lungs expand and function appears to improve. This type of blockage can be achieved by temporarily blocking the fetus’ windpipe (trachea) with a balloon for a period of time.
This is done by performing an operative fetoscopy, known as FETO. It is believed that FETO works by enhancing lung maturation and reversing some of the damaging effects of CDH on lung function.
2. Fetal monitoring and birth planning
There is a high probability that a baby with CDH will deteriorate before the expected due date. Part of a comprehensive care plan will involve close fetal and maternal monitoring to avoid severe fetal damage and to determine the circumstances and timing for optimal delivery.
Diaphragmatic Hernia Prevention
Currently, there is no known way to prevent CDH. Early and regular prenatal care during pregnancy is important to help detect problems before birth.
This allows for proper planning and care before, during and after delivery.
Some basic precautions that can help you avoid this condition include avoiding physical injury, including:
- Drive safely and always wear a seat belt.
- Avoiding activities that expose you to significant blunt injury to the chest or abdomen, such as extreme sports.
- Limit alcohol and avoid using drugs that can make you more accident-prone.
- Be careful around sharp objects, such as knives and scissors.
That’s the information about diaphragmatic hernia. Hopefully this information is useful.
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Republished with permission from theAsianparent Indonesia
