The document discusses congenital diaphragmatic hernia (CDH), including the risk factors, clinical presentation, radiologic findings, complications, and management. It notes that CDH is a birth defect involving an abnormal opening in the diaphragm, with the most common type being a Bochdalek hernia on the left side. Signs include breathing difficulties and abdominal abnormalities. Advances have allowed fetal treatments to be performed while still in the uterus.

1. Presented by: Myrna Macias and Amanda Aldrete

2. Identify the maternal, fetal and neonatal risk factors which predispose an infant to CDH. Describe the clinical presentation of CDH. Identify radiologic changes in the course of CDH. Identify complications associated with CDH. Discuss the management of an infant with CDH.

3. Which means, “present at birth ”. It simply means that a defect has been present since the time of birth.

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

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

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

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

8. Bochdalek hernia

9. Morgagni Hernia

10. Intestinal problems Hypoplastic lungs Pulmonary hypertension Decreased cardiac output Cyanosis

11. 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.

12. 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.

13. 12-15% of babies with CDH have other abnormalities such as hypoplastic heart or ventricular septal defect

14. 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.

15. 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

16. Liver position Liver-to-head ratio (LHR)

17. Liver down = Larger lung LHR estimates size of lungs LHR > 1.4 Good chance of survival LHR < 1.0 Difficult time with survival

18. At the Fetal Treatment Center at the University of California in San Francisco advances have been made that allow new medical treatments for CDH.

19. This new treatment is very different than conventional treatments in one way. It is completed while the baby is still in the mother’s uterus.

20. FETENDO HFOV NO ECMO

22. Congenital Diaphragmatic Hernia . Retrieved May 20, 2008, from http://www.chw.org/display/PPF/DocID/34373/Nav/1/router.asp Congenital Diaphragmatic Hernia . (2008, May 2). Retrieved May 20, 2008, from http://fetus.ucsfmedicalcenter.org/cdh/ Congenital Diaphragmatic Hernia (CDH) . Retrieved May 14, 2008, from http://www.chop.edu/consumer/jsp/division/generic.jsp?id=86686 Congenital Diaphragmatic Hernia . Retrieved May 14, 2008, from http://www.eapsa.org/parents/resources/diaphjramaticHernia.cfm Diaphragmatic hernia . (2007, July 26). Retrieved May 14, 2008, from http:/www.nlm.nih.gov/medlineplus/ency/article/001135.html 20/20, ABC, News. The Analisa Amen Story . (2008, April 1). Retrieved May 23, 2008, from http://fetus.ucsfmedicalcenter.org/cdh/analisa_amen.asp Hovsepian M.D., Michael , ., , Sheila, Berlin M.D.., Morrison M.D., Stuart, ., Meyers M.D., Melissa, ., Sivit M.D., Carlos, ., Weinert M.D., Dana, ., , Rainbow Babies, ., , Children's Hospital, . Case Fourteen-Congenital Diaphragmatic Hernia . Retrieved May 20, 2008, from http://www.uhrad.com/pedsarc/peds014.html