Birth Defects Respiratory Diaphragmatic Hernias

Diaphragmatic hernias are congenital abnormalities that affect the organs of the chest and abdomen. A hernia is a condition in which internal tissues protrudes though a wall by which it is normally contained as a result of a hole or weakness in the wall. In the case of a congenital diaphragmatic hernia, a weakness in the diaphragm allows abdominal organs to push through into the chest cavity.

The Diaphragm

In the human body, the diaphragm is the muscle that controls breathing. When the diaphragm contracts, it pulls down, increasing the size of the chest cavity and creating a vacuum in the lungs that results in inhalation of air. Relaxing the diaphragm reverses this process, forcing air out of the lungs.

The diaphragm also acts as a barrier between the chest cavity above and the abdominal cavity below. The diaphragm develops during the first trimester of pregnancy, and congenital malformations may occur at this time.

Functional Problems in Diaphragmatic Hernia

In a diaphragmatic hernia, the abdominal organs protrude through the malformed diaphragm, affecting their development and that of the lungs. Depending on the location of the defect, several abdominal organs of the gastrointestinal system may be affected. Two types of diaphragm hernia may occur:

  • Bochdalek hernia: The left side of the diaphragm is affected, and the intestines and stomach move into the chest cavity.
  • Morgani hernia: This one is on the right side of the diaphragm, and the intestines and liver move into the chest cavity.

Intrusion of these organs into the chest cavity can inhibit the growth of the lungs. In addition, the hernia interferes with breathing as it inhibits the proper movement of the diaphragm. Rapid breathing and poor oxygen saturation (sometimes evidenced by a blue tint to the skin called cyanosis) may result from a diaphragmatic hernia.

Diagnosis and Treatment of Diaphragmatic Hernia

A congenital diaphragmatic hernia may be diagnosed before birth using fetal ultrasound imaging. If so, babies can be delivered in a hospital prepared to handle their medical needs. Babies born with a congenital diaphragmatic hernia most often need to be admitted to the neonatal intensive care unit (NICU), as they need respiratory support from a ventilator.

In addition, some may need the extra help of extracorporeal membrane oxygenation (ECMO). A machine takes the blood from the body, oxygenates it externally, and then pumps the oxygen-rich blood back into the body. Surgery can improve lung function and repair the diaphragm.

After treatment, babies may continue to experience problems, including:

  • Chronic lung problems
  • Developmental delays
  • Failure to thrive (difficulties feeding and gaining weight)
  • Gastroesophageal reflux.

The prognosis, in terms of both surgery and later complications, depends largely on individual factors, including the type of hernia and the level of lung development.

Resources

Children’s Hospital Boston. (n.d.). Diaphragmatic hernia. Retrieved April 15, 2010, from: http://www.childrenshospital.org/az/Site741/mainpageS741P0.html.

Medline Plus. (n.d.). Diaphragmatic hernia. Retrieved April 15, 2010, from: http://www.nlm.nih.gov/medlineplus/ency/article/001135.htm.

University of California San Fancisco Children’s Hospital. (n.d.). Congenital diaphragmatic hernia.Retrieved April 15, 2010, from: http://www.ucsfchildrenshospital.org/conditions/congenital_diaphragmatic_hernia/treatment.html.