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by Scholten A
(Hernia—Diaphragmatic; Congenital Hernia of the Diaphragm)

Definition

Diaphragmatic hernia is a hole in the diaphragm that is present at birth. The diaphragm is the muscle between the chest and abdomen. Organs in the abdomen move through the hernia to the chest. They can push up against the lungs.

Causes

This problem is caused when the diaphragm does not form normally in the fetus. It is not clear why this happens. It may be due to genes or the environment.

Diaphragmatic Hernia—Stomach and Intestines Move into Chest Cavity
Herniated Diaphragm
Copyright © Nucleus Medical Media, Inc.

Risk Factors

Problems in the mother that may raise the risk are:

  • Obesity during pregnancy
  • Smoking or drinking during pregnancy
  • Low intake of vitamin A just before or during pregnancy

Symptoms

Symptoms may appear after birth or happen later. They may be:

  • Problems breathing, such as fast breathing or grunting
  • A blue tint to skin—from lack of oxygen
  • One side of the chest that looks larger than the other
  • A belly looks caved in
  • Feeding problems

Diagnosis

The diagnosis is often made before birth with an ultrasound.

In others, the doctor will ask about your child's symptoms a health history. A physical exam will be done. Images of the chest will be needed. This can be done with a chest x-ray.

Treatment

Treatment depends on how severe the condition is. Emergency care may be needed after the baby is born. It may include close monitoring and help with breathing and blood flow.

Surgery will be needed when the baby is well enough. It will move the organs back into place and repair the hole.

Prevention

There are no known guidelines to prevent this problem.

RESOURCES

Healthy Children—American Academy of Pediatrics  https://www.healthychildren.org 

Kids Health—Nemours Foundation  http://kidshealth.org 

CANADIAN RESOURCES

About Kids Health—The Hospital for Sick Children  http://www.aboutkidshealth.ca 

Health Canada  https://www.canada.ca 

References

Bent D, Nelson J, et. al. Population-based validation of a clinical prediction model for congenital diaphragmatic hernias. J Pediatr. 2018 Oct; 201: 160–165.

Congenital diaphragmatic hernia. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/congenital-diaphragmatic-hernia. Accessed January 15, 2021.

Congenital diaphragmatic hernia (CDH). Cincinnati Children's website. Available at: https://www.cincinnatichildrens.org/health/c/diaphragmatic-hernias. Accessed January 15, 2021.

Congenital diaphragmatic hernia (CDH). UCSF Benioff Children's Hospital Fetal Treatment Center website. Available at: http://fetus.ucsf.edu/cdh. Accessed January 15, 2021.

Revision Information

  • Reviewer: EBSCO Medical Review Board Marcin Chwistek, MD
  • Review Date: 02/2020
  • Update Date: 01/15/2021