Treating congenital diaphragmatic hernia
Stabilize your baby's breathing
A diaphragmatic hernia is a medical emergency. Your baby will need a breathing tube immediately after birth to help them breathe and prevent air from going into the stomach. The breathing tube is connected to a ventilator (breathing machine) to help with breathing. Some babies require heart/lung bypass with Extra Corporeal Membrane Oxygenation (ECMO), which gives the lungs a chance to recover so the doctors can do surgery to repair the CDH.
Repairing the congenital diaphragmatic hernia
When your baby is stable, the opening in the diaphragm is closed by an operation, usually through an incision in the upper abdomen. This surgery usually takes place within two weeks after your baby is born, depending on how much support they need in the first few days after birth.
During surgery, doctors will move the abdominal organs back into the belly and close the hole in the diaphragm. Sometimes, if the hole is significantly big or the diaphragm is missing completely on one side, we will use an artificial material to patch the diaphragm. Occasionally, this operation will be performed while the baby is on ECMO.
Recovery in the NICU
After surgery, your baby will recover in the NICU. Our pediatric anesthesiologist will use precisely calibrated medications to keep your baby comfortable during and after the operation and while weaning off the breathing machine. Children's Mercy has the highest-level NICU in the region.
Feedings with an NG tube
Your baby will have a nasogastric (NG) tube to keep their stomach and intestines empty until the intestines begin to work. This tube will be placed shortly after birth and will stay in place until feedings are started.
Once we begin to see signs that the intestines are working--such as a decreased amount of substance out of the NG tube and bowel movements--we can start feedings through a feeding tube that passes through your baby’s nose and into his/her stomach. If you're planning to breastfeed, we encourage you to pump breast milk that will be frozen and stored until your baby is able to receive feedings.
Feedings by mouth
Once your baby is able to have the breathing tube removed and is breathing comfortably on low amounts of oxygen, they can begin taking feedings by mouth. Some babies with diaphragmatic hernia need to go home on oxygen and/or with a feeding tube. Others are able to go home without oxygen and are able to take all feedings by mouth.
Going home after congenital diaphragmatic hernia
The length of stay in the NICU for an infant with this condition varies. Your baby will be able to go home when they can tolerate full feedings and are gaining weight. After discharge, your pediatrician will monitor your baby. Your baby will also come back to Children’s Mercy to see the pediatric surgeon or any other necessary specialists.