Currently the majority of babies with CDH are best treated after birth. The choice of therapy is in part dictated by the presence or absence of known predictive factors. These include the gestational age at initial diagnosis (less than 25 weeks is a poor prognostic indicator), the presence of part of the liver in the chest (poor indicator), the presence of polyhydramnios (too much amniotic fluid), presence of the stomach into the chest and the lung-to-head ratio (LHR), which is one of the more reliable indicators of prognosis.
For the most severe cases of CDH, extracorporeal membrane oxygenation (ECMO) is likely to be required. ECMO is a lung bypass machine that allows for gas exchange while the baby's lungs are resting and maturing. For babies with the worst cases of pulmonary hypoplasia, however, ECMO can only be used for a few weeks and does not allow enough time for the lungs to grow or mature to live. Additionally, ECMO carries significant risks including long-term damage to the lung, brain and other organs.
Currently most cases of prenatally diagnosed CDH are best managed after birth. Cases with intermediate severity, where there is still a significant possibility that the baby's lungs won't function well enough at birth and may require the use of ECMO, are delivered in the presence of our full team of experts. In rare cases with the worst prognosis, intervention before birth to include single port endoscopic fetal tracheal occlusion to allow accelerated lung growth will be offered.
Babies with highest risk diaphragmatic hernia, where the chances of survival is estimated at less than 10-40 percent, endoscopic fetal tracheal occlusion will allow accelerated lung growth to occur enough that it will convert the severe condition into a condition with intermediate or good prognosis, and a predicted survival greater than 50-65 percent.
| More about Pediatric Surgery at Hasbro
The Fetal Treatment Program is a partnership of Hasbro Children's Hospital, Women & Infants' Hospital and The Warren Alpert Medical School of Brown University.