What is a Diaphragmatic Hernia

What are the symptoms

How is it treated

What about the surgery

What can a parent do

The diaphragm is a muscle that separates the thoracic (chest) cavity from the abdominal cavity.

	The thoracic or chest cavity contains the heart and lungs
	The abdominal cavity contains the stomach, liver, spleen, intestines and other organs.

A congenital diaphragmatic hernia is a defect (opening) in the diaphragm that allows the abdominal organs to move up into (herniate) the thoracic or chest cavity. 

Congenital defect means it is present at birth.

The defect occurs prior to the 12^th week of pregnancy.

It occurs in males more frequently than females.

When the abdominal organs occupy the thoracic cavity it may interfere with the normal growth and development of one or both of the lungs.

The lung on the side of the hernia is small, has a decreased number of blood vessels, and has difficulty performing the normal functions of a lung. 

The heart may be shifted to opposite side (right side) of the chest.

Sometimes the defect is diagnosed by an ultrasound done during the mother’s pregnancy.  

If it’s not diagnosed during a pregnancy, the diagnosis is made shortly after birth.

Symptoms may include: 

	Tachypnea  (breathing fast)
	Cyanosis  (bluish coloring to the skin, lips, etc.)
	Nasal flaring  (increase in size of opening of nose during breathing)
	Large barrel-shaped chest
	Absent or diminished breath sounds on the side where the hernia is
	Distant or muffled (hard to hear) heart sounds
	Flat abdomen  (also known as a Scaphoid Abdomen)

A Chest x-ray is usually ordered and will confirm the abdominal organs in the chest space. 

The baby will be intubated (breathing tube placed in the windpipe) and placed on respiratory support (ventilator) to improve and maintain his oxygenation. 

We will pass a tube through the baby’s mouth and into his stomach (known as an orogastric or OG tube) to decompress (let out) any air that has accumulated (built up) there.  This makes it easier for us to support his respirations.   

He will receive medications for any or all of the following reasons: 

	To fight infection
	To support his blood pressure
	To make changes in his blood gases

We will start several IV lines that will be used to give the baby nutrition, give medications, and to draw lab samples.   

The doctor may order an electrocardiogram (also known as a ECG or EKG) to see if the heart is working as it should. 

We will ask a surgeon to come and evaluate the baby for surgery to correct the defect (hernia). 

	The surgeon will do the surgery once the baby’s respiratory status has improved and is stable.
	The surgeon will talk with you after he has seen the baby.

Our neonatologists will also talk with you about the baby’s condition.  

If you have any questions or concerns, please talk with us.

Surgery may be performed at Cape Fear Valley Medical Center or the baby may be transferred to either Duke University Medical Center or The University Hospital at Chapel Hill for the surgery.

	If the decision is to transfer your baby to another hospital you will be asked to sign a consent giving Cape Fear Valley Medical Center permission to transfer your baby.
	If your baby is transferred to another hospital, the doctors there will also talk with you about your baby’s surgery.

The surgery is done in the Operating Room and the baby is asleep for the surgery.  You will be asked to sign a consent (give permission) for the surgery.

Once your baby’s condition is stable and the doctors are happy with the baby’s progress, the baby may be returned to Cape Fear Valley Medical Center’s Neonatal Intensive Care Unit.

 Keep up with your baby’s progress each time you visit or call.   

An important part of the baby getting better is the parents’ love and concern.  

We encourage you to talk and sing to your baby, gently touch or rub them and hold them close if possible.  Talk with your baby’s nurse about this.   

 Your love and attention will go a long way in helping your little one on the road to recovery.