Understanding Congenital Diaphragmatic Hernia (CDH)

👶 What Is CDH?

CDH occurs when a hole in the diaphragm allows abdominal organs to migrate into the chest cavity, impairing lung development. It affects roughly 1 in every 2,500–3,000 live births. Pulmonary hypoplasia (underdeveloped lungs) and pulmonary hypertension are common complications. Early recognition, skilled resuscitation, and careful NICU management make a huge difference in outcomes.

🧠 Types of CDH

Each hernia type presents slightly differently. Here’s a breakdown:

Bochdalek Hernia (Most Common – 80–85%)

• Location: Posterolateral defect, typically on the left.

• Contents: Stomach, bowel, liver, spleen may herniate.

• Effect: Lung compression and mediastinal shift.

Bochdalek Treatment

• Stabilize respiratory status in the NICU.

• Delay surgery until baby is stable.

• May require patch repair if the defect is large.

Morgagni Hernia (~2–5%)

• Location: Anterior and retrosternal, usually right-sided.

• Often asymptomatic or discovered on imaging.

Morgagni Treatment

• Usually elective surgery.

• Can often be repaired laparoscopically.

🩺 How Is CDH Diagnosed?

Antenatally

• Routine ultrasound (~20 weeks) may show stomach or liver in chest, mediastinal shift, or polyhydramnios.

• Fetal MRI may assess lung size using the Lung-to-Head Ratio (LHR).

Postnatally

• Presents as respiratory distress shortly after birth.

• Signs include a scaphoid abdomen, decreased breath sounds, and displaced heart sounds.

• Chest X-ray confirms diagnosis (bowel in chest cavity, heart pushed aside).

😮‍💨 Symptoms After Birth

• Immediate respiratory distress

• Cyanosis, tachypnea

• Barrel chest with poor air entry on one side

• Scaphoid (sunken) abdomen

🆘 Resuscitating a Baby with Known Severe CDH

• Prebrief your team—have a full resuscitation plan in place.

• DO NOT bag-mask ventilate—this increases abdominal gas and worsens lung compression.

• Immediate intubation

• OG/NG tube to continuous low wall suction

• Gentle ventilation strategy—avoid high pressures

• Prepare for arterial/central access, inhaled nitric oxide, or ECMO if indicated

🏥 NICU Admission – What to Expect

• Intubation at birth

• Arterial and central lines for close monitoring and access

• Continuous suction to stomach via Replogle or sump tube

• Ventilator management focused on lung-protective strategies

🧾 Common Co-Morbidities

• Pulmonary hypoplasia

• Persistent Pulmonary Hypertension of the Newborn (PPHN)

• Feeding intolerance and GERD

• Risk of neurodevelopmental delays

• Chronic lung disease in some survivors

🕰️ Long-Term Outcomes

• Highly variable. Some infants thrive with minimal support; others need long-term help.

• May require oxygen, feeding tubes, or physical/speech therapy.

• Risk of recurrence and chronic issues, including pulmonary or GI complications.

👨‍👩‍👧 Parent Education & Follow-Up

• Provide clear explanations about CDH and the care plan.

• Reassure families—NICU teams are experienced in managing CDH.

• Daily updates from care team.

• Support parent involvement in kangaroo care and routine tasks.

• Prepare families for the home transition with feeding plans and referrals for therapy and early intervention.

🔁 Recap

CDH is a complex neonatal condition with varied outcomes. Nurses must understand the types of hernias, signs, and critical interventions from delivery room to discharge. A gentle ventilation strategy, careful monitoring, and strong parent communication are key to success. With multidisciplinary support, even babies with severe CDH can thrive.