Treatment for congenital diaphragmatic hernia is surgery to gently move your child's abdominal organs down from the chest and close the hole in the diaphragm. Once this is done, your child's lung size should slowly increase over time.
Your baby may have the surgery very soon after birth, or doctors may wait days or weeks to do the operation. The timing often depends on the baby's condition and the degree of high blood pressure in the lungs.
Before Surgery for CDH
Most babies with CDH will be on a breathing machine (ventilator) before surgery. After surgery, some will be on a ventilator until their lungs are ready to take over. Depending on the severity of the CDH, the time on the ventilator may be very short, or it may be weeks.
Some infants require extracorporeal membrane oxygenation (ECMO) treatment, a form of life support that does the work of the lungs and heart for patients during or after surgery. Some infants may also need a tube that passes through the nose into the stomach (nasogastric or NG tube). This tube can keep air out of the intestines so they don’t press on the lungs.
CDH Surgery Options
There are several ways to perform the operation to move organs into the belly and close the hole. The choice will depend on your child's condition. Your baby's surgeon will talk with you about the options and make a recommendation for your child. No matter which technique your baby's surgeon uses, we will give your child medicine to make them sleep without pain during the surgery (general anesthesia).
Some children can have the operation performed using a thin, lighted tube with a camera attached, called a thoracoscope. This means surgeons can make a few small cuts (incisions) to insert the tube and their surgical tools.
For other children, it is best to make a small incision either in the chest or abdomen to perform the surgery. No thoracoscope is used.
After moving the organs, the surgeon will sew closed the hole in the diaphragm. If the hole is too large to sew up, the surgeon will attach a patch to close the hole. This patch will stay inside your child's body. We use a patch, invented at Seattle Children's, that has the lowest reported rate of failure in the medical literature.
How long surgery for CDH takes depends on the size of the hole, how many organs the surgeon needs to move, and how healthy your baby is overall. Before surgery, the surgeon can give you an estimate of how long it will take.
At the time of surgery, many children need a chest tube. This allows any fluid that collects in the chest to drain out. The tube usually needs to stay in place for a few days.
After CDH Surgery
After surgery, your child will be in the recovery room for an hour or so. Most babies then stay in our Level IV neonatal intensive care unit (NICU), where they receive the highest level of care. When they're ready, they move to a regular hospital room. Seattle Children’s is the first hospital in Washington to have a Level IV NICU.
The length of hospital stay for babies with CDH may be as short as a few days to as long as many months. This depends on factors like the extent of the surgery and how long it takes for your child to breathe well without a ventilator.
If your child goes home quickly, the surgeon will schedule a follow-up visit two to three weeks after the operation to make sure the incision is healing well. If your child stays in the hospital longer, the surgeon will stay closely involved with your child's care while they are in the hospital.
After your child goes home, keep the incision clean and dry until it heals. The surgery team will teach you how to care for the incision and what kinds of food or medicine to give your child.