Congenital Diaphragmatic Hernia in Babies – What is it, Types, and Complications

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Congenital diaphragmatic hernia (CDH) is an abnormality that forms when the baby is developing in the womb. CDH emerges because of a hole in the diaphragm. A diaphragm acts as a wall between the organs of the chest and the organs of the abdomen. In babies with this type of hernia, the wall has a hole or a weak spot in one of its regions.

As a result, the abdominal organs like the stomach, liver, pancreas, gallbladder, and intestines can pass through the hole and crowd the cavity of the lungs and heart. This is a very crucial time of growth for all the organs. Being congested together won’t allow them to grow healthily. Therefore, lungs very often struggle to grow normally in babies with CDH resulting in respiratory issues. But yes, medical science has evolved considerably to treat these problems.

Causes of CDH In Babies

Before childbirth, the placenta membrane acts as a bridge that supplies oxygen and nutrition to the baby through the umbilical cord. Therefore, while a baby is growing in the womb, they won’t face any breathing problems. But post-delivery, a baby depends on their own lungs for oxygen supply. And if the lungs are severely underdeveloped, external ventilation support is provided.

The diaphragm attains complete formation when the fetus is at around 10 weeks of gestation, meaning, 10 weeks after conception. CDH leads to improper development of the diaphragm. And some holes are left behind, through which some organs can enter into it. It is called herniation.

CDH can occur due to chromosomal abnormality. Chromosomes are like recipe books that act as manuals for the formation and development of organs. Any typos, or blank pages, i.e., abnormality causes improper organ formation.

Some other potential causes are genetics, fetal malnutrition, and toxic environmental exposure while pregnant.

Types of Congenital Diaphragmatic Hernia in Babies

Based on the severity of the birth defect, congenital diaphragmatic hernia is classified in mainly two types

1. Bochdalek Hernia

In around 90% of cases of CDH in babies, this type is found. See the diaphragm muscle as a 5 cm thick curtain for example. In any of the regions of the curtain, there can be a 5cm thick hole, meaning; a complete hole. Through it, the abdominal organs can enter the chest cavity and cause major lung and heart problems.

2. Morgagni Hernia

In this type, the hole is not complete. To recall the previous example, the hole is not a whole 5cm thick but can be 2 cm or even 4 cm. The abdomen’s organs do not intrude into the chest area directly. But like a balloon, the diaphragm muscle bulges up because of the organs beneath. It can potentially cause lung problems but it’s rare.

Signs and Symptoms of CDH in Babies

From mild problems to severe life-threatening conditions, CDH symptoms can vary in seriousness. Sometimes, babies don’t have any symptoms or problems. But often, the infant’s organs and body parts struggle to get proper oxygenation. Here are some of the symptoms

1. Breathing issues because of small lungs not able to function optimally (pulmonary hypoplasia).
2. Developmental problems associated with the heart.
3. High blood pressure causes functional difficulties in the heart’s right side and the lung’s arteries.
4. Wounds or damage to the organs like the liver, intestines, stomach, pancreas and so on because of not being in their proper places.

Complications of CDH in Babies

In all the years of diagnosing babies with congenital diaphragmatic hernia, doctors found underdeveloped lungs the most common complication. This gives birth to a multitude of problems;

1. Pulmonary Hypertension

In this condition, the lungs’ arteries have high blood pressure. Because the right ventricle of the heart gets exposed to severe pressure, heart failure can happen.

Here is an easy example to understand Pulmonary hypertension. Suppose ten people are eating at a Japanese Conveyor Belt restaurant. The belt is moving at a moderate speed and is filled with one cuisine every 10 cm distance. Those ten customers won’t have to wait very long for their turn. Suddenly, the number of cuisines is reduced – one cuisine every 100 cm distance. The speed of the Conveyor belt has to be increased so that the customers don’t get impatient.

Similarly, babies with CDH have less oxygen supply in their bodies for their organs, just like the conveyor belt had fewer meals for customers. So, the heart has to speed up or pump more blood in the same amount of time. This is so that the organs don’t get impatient or don’t fail from a limited energy supply.

2. Hypoxemia

Hypoxemia refers to reducing oxygen levels in the blood. As we understood earlier, there’s not enough oxygen in the blood. Therefore, all the body’s organs aren’t able to function optimally. If left untreated, the organs may face irreversible damage.

3. Difficulty Feeding

Surgical interventions at birth to treat CDH may leave a baby dependent on tube feeding for a long time. This also means there will be some developmental delays like delayed speech, standing, walking, etc.

Diagnosis of CDH in Babies

If a baby has CDH, it can be discovered by routine prenatal ultrasound checkups. Or, after childbirth, the doctors can identify CDH by looking at the chest, abdomen area, etc. which give signs.

Treatment Of CDH in babies

The doctors will fix the hernia through surgery and will move the organs to the right places. Post-surgery, the baby will need to be fed using a feeding tube for some time. A team of healthcare providers will accompany the parents or the caregivers as long as it’s needed.

When to See a Doctor?

A mother should attend her routine prenatal ultrasound checkups. The doctor will inform you if the baby shows any symptoms of CDH. Post-birth the doctors may be able to identify this condition during medical checkups and examinations. If you feel that your baby is struggling to breathe or is showing symptoms that may be indicative of CDH, you may need to see the doctor immediately.

Medical science, today, has broken through the roof of numerous technological limitations. CDH in babies is treatable, and with further support, the little one can live a very normal life and can even thrive.

FAQ’s

1. Can CDH Correct Itself?

No, without medical intervention, CDH cannot heal by itself. This is a condition that needs medical supervision, diagnosis and treatment in the form of surgery as warranted by the doctor.

2. Is CDH genetic?

The exact cause of CDH remains yet to be known. But yes, there can be some genetic contribution to the condition. Medical experts are still finding answers to the reasons behind the occurrence of this condition.

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