16 terms

Congenital Diaphragmatic Hernia (CDH)

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What is CDH?
- A birth defect when the diaphragm does not properly form during fetal development
- an opening in the diaphragm allows for the intestines, or other abdominal organs to migrate into the chest cavity
What occurs most often a right side or left side CDH?
Left side 80-85%
What week of gestation does the diaphragm not develop properly?
7-10 weeks
what is the cause of CDH?
uknown
What causes the pulmonary hypoplasia?
Abdominal organs in the chest cavity on the affected side
When is CDH usually diagnosed?
18-20 weeks
What is fetal care of CDH?
Routine ultrasounds
Chromosome analysis
referral to fetal care center
tertiary hospital for evaluation and birth plan
How is the delivery different than normal delivery?
Preferably a planned delivery
intubate immediately
EXIT birth
ECMO
what is EXIT birth?
baby is partially delivered and still connected to the umbilical cord. surgeon then establishes an airway so the fetus can breath. then infant is fully delivered
What are the signs for CDH?
cyanosis
retractions
tachycardia
tachypnea
scaphoid abdomen
absent breath sounds on affected side
asymmetrical chest rise
abnormal breathing pattern
What are the breath sounds in CDH?
absent breath sounds on affected side
bowl sounds in chest
who is involved in an infant with CDH?
surgeons
neonatologist
advance practice nurses
respiratory therapist
occupational therapist
speech therapist
nutritionists
what is an acute treatment plan for CDH?
-supporting respiratory status through gently ventilation
-supporting nutrition (TPN/lipds via IV)
-decompressing stomach (NG)
-treat pulmonary hypertension
-ECMO if necessary (approx. 30% of CDH)
-surgical repair when stable
What is long term treatment plan for CDH?
-difficulty in tolerating may occur in CDH
-a feeding tube may be necessary (short or long term)
- follow-up with physical, speech, and occupational therapy to evaluate development milestones
-long term respiratory support depend on degree of chornic lung disease
- oxygen therapy, trach, or ventilator support may be necessary long
- control pulmonary hypertension through medication, repeat echocardiograms
what is the prognosis for congenital diaphragmatic hernia?
serious life threatening congenital defect
varies from case to case:
- gestational age
- severity of pulmonary hypertension
- severity of pulmonary hypoplasia
what is the survival rate for CDH?
80-90%