cdh.pptx

MS. CHETNA KUMARI
ASSISTANT PROFESSOR
CHILD HEALTH NURSING

Which means, “present at birth”. It simply
means that a defect has been present
since the time of birth.
PROGRAMME- B.Sc. Nursing Course- Child Health Nursing

•A congenital
diaphragmatic hernia
is a birth defect where
there is an abnormal
opening in the
diaphragm.

• Rate of about one in
every 2,500 births.
•
•
The left-sided Bochdalek
hernia is seen in
approximately 90% of cases.
The Morgagni hernia, a
less- common, occurring
in only 5- 10% of cases of
CDH.

TYPES OF CDH
There is 2 types of Congenital Diaphragmatic
Hernias.
Bochdalek Hernia – which
involves an opening on the left
side of the
chest.
Morgagni Hernia – which involves
an opening on the right side
of the chest.

BOCHDALEK HERNIA
•
•
•
•
Most common type of
hernia (left sided hernia)
Makes up 90% of all cases
Slightly more common in
boys
Shifting of the heart and
the mediastinal to the left,
causing cardiac
compression

• Uncommon type
of hernia (right)
•
•
•
Makes up 2% of
all cases
More common in
girls
Signs and
symptoms may or
may not be
present

•
•
•
•
•
Intestinal problems
Hypoplastic lungs
Pulmonary hypertension
Decreased cardiac
output Cyanosis

Inherited genetically from the
parents.
•
•
•
Result of damage or infection in the uterus, or
may have occurred at time of birth.
Most commonly seen on the left side of the body
but may also occur on the right side or the central
portion of the diaphragm.

PATHOPHYSIOLOGY

Present at birth:
Rapid and shallow breathing
Tachycardia (>180 bpm)
,Cyanosis
Paradoxical breathing
Breath sounds absent on the affected
side. Bowel sounds heard in the chest.
Concave abdomen that feels less full
when touched.

• 12-15% of babies with CDH have other
abnormalities such as hypoplastic heart or
ventricular septal defect

Made before birth by ultrasound of the
fetus Excess amounts of amniotic fluid
•
•
• Other tests such as fetal MRI, chromosome
studies and fetal echocardiogram may also be
done

CONT…
CT Scan
Fetal MRI

• MEDICAL MANAGEMENT:-
Vasoactive agents to increase cardiac
output eg.- Dopamine,Dobutamine.
Mechanical ventilation for respiratory
distress.
Perform surgical reduction of hernia and
repair defect after respiratory status is
stable.

PRENATAL MANAGEMENT OF CDH
Follow-up ultrasound exams should be
performed every four weeks throughout the
pregnancy to evaluate your baby’s growth
and activity.

Delivery of babies with CDH
You can expect delivery around 38-39
weeks for your baby with CDH. Most babies
with CDH are born vaginally unless there
are obstetric indications for a cesarean
delivery
PROGRAMME- B.Sc. Nursing

ECMO (extracorporeal membrane
oxygenation )
A temporary heart-lung bypass technique used to
oxygenate the blood and allow the lungs to rest.
Under sterile conditions at the bedside and once
your baby has received pain medication, the
pediatric surgeon will place two tubes called
cannula into the artery and vein in your baby’s
neck.
The tube in the neck takes blood out of the body
from the large vein, oxygenates the blood through
the ECMO circuit and returns the now oxygenated
blood to the baby by the carotid artery.

AFTER REPAIR
PROGRAMME- B.Sc. Nursing Course- Child

COMPLICATIONS
•Pulmonary hypoplasia
•Gastric vovulus (abnormal rotation of
stomach)
• Renal hypertrophy

NURSING DIAGNOSIS
Risk of ineffective tissue perfusion related
to hernia and possibility of obstruction
Acute pain related to pressure
Risk of aspiration related to reflux of
gastric content
Fear and anxiety related to hospitalization

Stabilisation/resuscitation at birth
•Intubation immediately after birth with no bag
mask ventilation
•Do NOT undertake delayed cord clamping
•Stomach decompression with nasogastric tube
•Weigh before transfer to incubator
•Update parent(s) before leaving the room

Stabilisation in NICU
•Commence conventional ventilation as per ventilation
section
•Measure pre and post ductal saturations
•Central venous access - double lumen umbilical venous
catheter.
•Sedate and consider paralysis
•Maintain mean arterial pressure in normal range for
gestation with fluid boluses +/- inotropes
•Obtain a chest X-Ray

Ventilation
•The aim is to achieve preductal SaO₂ 80-95% in the
delivery room and initial 1-2 hours of life.
•All hand bagging requires an in-line manometer or
pressure controlled T-piece.
•If oxygenation and/or ventilation goals cannot be met with
a PIP ≤28cmH₂O with conventional ventilation then HFOV
may be used as a rescue therapy.
•There is no role for routine use of surfactant

CONCLUSION
Congenital diaphragmatic hernia should be
detected at the prenatal anomaly ultrasound
examination. Additional anomalies should be
searched for and appropriate genetic testing
offered.
The severity of the condition should be assessed
using ultrasound and possibly prenatal MRI. In
utero referral to a centre experienced with the
postnatal management of CDH is mandatory to
optimise outcome.

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