Congenital Diaphragmatic Hernia (CDH)

What is congenital diaphragmatic hernia?

CDH is a condition where there is a hole in the muscle that separates the chest and the tummy. Because of this hole, some of the baby’s organs, like the stomach or intestines, can move up into the chest. This can make it harder for the baby’s lungs to grow properly. There are two types of CDH:

Left-sided CDH: 
This is the most common type. It happens when the hole is on the left side of the baby’s diaphragm. The stomach and intestines can move up into the chest, which can push the heart slightly to the right.

Right-sided CDH: 
This is less common. It happens when the hole is on the right side of the diaphragm. The liver can move up into the chest, which sometimes makes this type more serious because the liver is a large, solid organ.

Both types can affect how the baby’s lungs grow, but the effect can vary from baby to baby.

What causes CDH?

CDH happens during early development of the diaphragm. We do often do not know exactly what causes CDH but can sometimes be linked to genetic or chromosomal conditions.

How CDH diagnosed?

CDH is usually seen on a pregnancy ultrasound, often at the 20-week scan. The scan may show abdominal organs in the chest or the heart pushed to one side.

What does it mean for my baby?

The seriousness of CDH can be different for each baby. It can affect how the lungs grow, which may make it hard for the baby to breathe after birth. Some babies may need help to breathe or may need an operation soon after they are born.

What happens next?

If your baby is thought to have CDH, you will be referred to a fetal medicine team. This team specialises in caring for mothers and babies with this condition. They might be at your current hospital, or you may need to visit another hospital. The fetal medicine team will need to perform another ultrasound scan to confirm if your baby has CDH and will give you information, support, and care throughout your pregnancy.

What happens after birth?

Treatment for babies with CDH depends on how severe the condition is, but it usually involves:

-  Specialist care after birth: Babies with CDH are looked after in a neonatal intensive care unit (NICU) by a team of doctors and nurses who specialise in newborn care.

-  Help with breathing: Many babies need a breathing machine (ventilator) to help them breathe after birth because their lungs may be small or not fully developed.

-  Surgery: Once the baby is stable, a surgeon will repair the hole in the diaphragm by moving the organs back into the tummy and closing the opening.

-  Ongoing care: Some babies may need extra help with feeding, breathing, or growth as they get older, and they will be followed up by specialist doctors.

Will it happen again?

CDH usually happens once and is not inherited. If it is linked to a genetic condition, you may be offered testing and counselling with a specialist team.