a risk factor for neonates

1. DIAPHRGMATIC HERNIA
PRESENTED BY- JAISHREE
MPT (PEDIATRIC)

2. The diaphragm developed at 8 weeks’ of gestation
1.Septum transversum
2.Pleuroperitoneal membrane
3.Dorsal mesentery of the esophagus
4.Body wall

3. DEFINTION
• Communication between the abdominal and thoracic
wall with or without abdominal content in thorax, a
defect, called as diaphragmatic hernia
• Hole is developed between chest and abdominal wall
• Predominance of hole is on left side which allows the
abdominal content to pass into the chest cavity

4. Types
ACCORDING TO ETIOLOGIC
Congenital Traumatic

5. CONGENTIAL DIAPHRGMATIC HERNIA
• Congenital diaphragmatic hernia (CDH) is a birth
defect of the diaphragm.
• The most common type of CDH are
• Bochdalek hernia(posterolateral)
• Morgagni hernia(retrosternal)
• Diaphragm eventration
• Central tendon defects of the diaphragm

6. Traumatic diaphragmatic hernia
Injury may occur due to both penetrating and blunt traumas
In 50-80% of blunt diaphragmatic rupture the left hemidiaphragm is
injured
The right hemidiaphragm in injured in 12-40% of cases
Common type are-
• Hiatal (oesophageal hiatus)
• Paraesophageal

7. PATHOPHYSIOGY
• Abdominal organ hernia
• Compression of thoracic viscera
• Pulmonary atelectasis
• Significance loss in functional capacity
• Compression of great veins
• Leads to deceased venous return
• Results in deceased cardiac output

8. CLINICAL PRESENATION
• Malformation of the diaphragm allows
the abdominal organs to push into
the chest cavity.
• Hindering proper lung formation

9. CAUSES
• Pulmonary hypoplasia
• Pulmonary hypertension
• Respiratory distress

10. SIGN AND SYMPTOMS
• Respiratory distress
• Cardinal sign present like (grunting, cyanosis)
• Use of accessory muscle
• Increased chest diameter
• Decreased or absent breath sound at site of hernia

11. Delayed presentations
• Regurgitation
• Ischemia
• Sepsis
• Shock

12. INVESTIGATION
• Amniocentesis and maternal serum is advice in children with
genetic history of CDH
• Sonography
• X-ray
• Magnetic resonance imaging MRI, CT scan
• SpO2
• ABG analysis
• Pulmonary function test
• Cardiopulmonary exercise testing

13. INTERVENTION
• To prevent haemorrhage, hypovolaemic shock and cardiac
arrythmia Ventilatory strategies is required in advance cases-
Conventional mechanical ventilation
HFOV
Extracorporeal membrane oxygenation (ECMO)

14. Surgical intervention
• Median sternotomy, lateral thoracotomy, transthoracic surgeries
• Laparoscopic and thoracoscopic repair of hernial hole
• Liquid ventilation
• Tracheal occlusion

15. Complication
• Delayed growth in early years of life
• Neurocognitive defects
• Structural deformity like scoliosis and pectus excavatum
• Gastroesophageal reflux diseases
• Intestinal obstruction

16. PHYSIOTHERAPY INTERVENTION
• Breathing exercises- Deep breathing exercises with 3 sec hold
• Purse lip breathing
• Paper blowing or incentive spirometry
• Active cycle of breathing technique
• Thoracic expansion exercises
• Coughing and huffing technique
• Transcutaneous electrical nerve stimulation

17. THANK YOU