Congenital Diaphragmatic Hernia Repair (Pediatric)
MEDICAL ANIMATION TRANSCRIPT: A congenital diaphragmatic hernia is a birth defect, in which an abnormal opening in a baby's diaphragm allows abdominal organs to move into the chest. The diaphragm is a large, dome-shaped sheet of muscle that separates the chest from the abdomen. When the baby breathes in, the diaphragm and outer rib muscles contract, expanding the chest cavity. This expansion lowers the air pressure inside the chest, creating a pressure change that causes air to rush into the lungs. When the baby breathes out, the diaphragm relaxes and the inner rib muscles contract, reducing the size of the chest cavity. This reduced size increases the air pressure inside the chest, forcing air out of the lungs. For unknown reasons, the diaphragm in some babies doesn't develop completely before birth, resulting in an opening between the chest and abdomen. The most common location for this opening is on the left side of the diaphragm, near the back. The baby's abdominal organs can push through-- or herniate-- through this opening in the diaphragm and compress the lungs. As a result, the lungs do not develop fully, causing the baby to have significant trouble breathing right after birth. Before the operation, the baby will be given general anesthesia to put him or her to sleep for the entire operation. A breathing tube, inserted soon after birth through the nose or mouth and down the throat, will continue to help the baby breathe during the operation. Usually, the surgeon will make an incision under the ribs on the left side. Next, the surgeon will carefully move the abdominal organs from the chest back to their normal place in the abdomen. If the hole in the diaphragm is small, it will be closed with sutures alone. If the hole is too large, or there isn't enough muscle to close it, a patch will be sewn over it. Finally, the incision will be closed with dissolvable sutures or closure tape dressing. After the operation, the baby will be taken to the neonatal intensive care unit for monitoring. A mechanical ventilator machine will help the baby breathe for a few days or several weeks. Pain medication will be given. The baby may continue to receive antibiotics through the IV. The hospital stay may last for weeks or months, depending on the size and condition of the baby's lungs. If a patch was used, the baby's growth will need close monitoring, because the patch doesn't grow and may start to pull away from the hole.