Diaphragmatic Hernia

Front 1

Definition DH

Back 1

developmental defect of the diaphragm that allows abdominal viscera to herniate into the chest

Front 2

lung compression by hernia leads to?

Back 2

pulmonary hypoplasia

Front 3

Diaphragm ebryology

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formed in 8th week,
visceral herniation occurs during lung development,
failure of normal closure of the pleuroperitoneal folds during the 4th to 10th

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Location of the Hernias

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posterolateral (Bochdalek hernia)
peristernal (Morgagni hernia)
anterior retrosternal
Left side herniation 80 %

Front 5

describe the pulomary hypoplasia effects

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the ipsilateral side is affected due to compression
decrease in pulmonary mass, reduction in the number of bronchial divisions, respiratory bronchioles and alveoli. These abnormalities limit the gas exchange

Front 6

Diaphragmatic agenesis

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Anatomically, diaphragmatic agenesis is the most extreme form of CDH

Front 7

CDH effect on lugns lead to?

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hypoxia, hypercarbia, acidosis

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Prenatal diagnosis

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Ultrasound can be seen.
Mean gestational age is 24 weeks

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POSTNATAL DIAGNOSIS

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Respiratory distress immediately after birth
tachypnea, cyanosis, chest retraction
Breath sound is less audible.
Can hear intestinal sounds in the chest

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Associated anomalies

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in 40 -50 % of cases there are anomalies.
Chromosal abnormalities most freq one
Facial dysmorphology, distal digital hypoplasia, and cardiac/renal/brain anomalies

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Prognostic Factors Diaphragmatic hernia

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worse in the setting of an abnormal karyotype, severe associated anomalies, liver herniation, and fetal lung volume.

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When suspect CDH ultrasound you do

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Ultrafast fetal MRI to look for associated abnormalities and liver herniation
Fetal echocardiography
Fetal karyotype

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Prenatal treatment of CDH

Back 13

Glucocorticoids

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Postnatal treatment of CDH

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Low peak pressure, goal <25cm H20
to minimize lung injury
Nasogastric tube to decompress abdominal contents
Umbilical artery line placed for frequent monitoring of blood gases and blood pressure

Front 15

When is ECMO indicated?

Back 15

Inability to maintain preductal saturations >85 percent or postductal PaO2 >30. Peak inspiratory pressure >28 cm H2O or mean airway pressure >15 cm H2O
Hypotension that is resistant to fluid and inotropic support
Inadequate oxygen delivery with persistent metabolic acidosis

Front 16

Surgical repair

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first vascular stabilisation most important
then surgical after 48 to 72 hours
reduction of the abdominal viscera and primary closure of the diaphragmatic defect

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Outcome CDH

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With a proper therapy and no associated anomalies, the survival rate is about 80%.
If we have other problems, the average survival rate is about 50%.