What to Expect After Your Baby is Born

Delivery

Most women can proceed with a vaginal delivery, unless other medical reasons require a cesarean delivery.

Babies with CDH are at increased risk of respiratory problems and may require specialized treatment immediately upon delivery, including ECMO (extracorporeal membrane oxygenation), a heart-lung bypass machine that performs the work of the heart and lungs so the organs have time to rest or grow. Even those with good prognostic signs on prenatal imaging will need highly specialized care in an experienced neonatal intensive care unit (NICU).

We recommend all babies with CDH be delivered in a center capable of caring for the most critically ill newborns, avoiding the need for a potentially life-threatening transfer.

Delivery at a center like Texas Children’s Pavilion for Women provides for the best possible outcome, enabling mother and baby to receive expert care in one comprehensive location. With our level IV NICU and immediate access to pediatric surgical care after birth, we are well-equipped to manage a high-risk delivery and provide the specialized care required by these babies. Texas Children’s also offers small, family-centered classes to help families prepare for their newborn's hospitalization following delivery.

Delivery and postnatal care should be carefully planned and coordinated with a team of maternal-fetal medicine specialists, neonatologists, and pediatric surgeons highly experienced in working together to treat CDH.


Treatment after Birth

After your baby is born, a breathing tube is placed, as well as a tube through the mouth or nose into the stomach to decompress the intestines within the chest to allow for lung expansion.  Until the hernia is surgically corrected, intravenous nutrition will also be needed.

Every baby with CDH is different. Although we closely monitor and try to gauge how severe the CDH is while they are in utero, the amount of support and treatment that will be needed at birth is uncertain.

At Texas Children’s, our specialized group of neonatologists and pediatric surgeons are well-versed in the treatment of newborns across the full spectrum of CDH, from medications to treat pulmonary hypertension, to high-frequency oscillatory ventilators, to extracorporeal membrane oxygenation (ECMO).


Surgical Repair

The timing of surgery to repair the hernia after birth, and the length of hospital stay, depends on the severity of your baby’s CDH and the amount of support needed. Typically surgery is performed within the first week of life after your baby has stabilized from the birthing process, either on a ventilator or on ECMO.

During the procedure, an incision is made just below the rib cage. The intestines and other abdominal organs are removed from the chest cavity and placed back in the baby’s abdomen. The hole in the diaphragm is then closed with stitches. In cases where the hole is very large, a prosthetic mesh patch is used to help close the defect.

After the repair, a chest tube and sometimes a drain are left to allow excess fluid to flow out of the baby’s chest and help the lungs expand.

Following surgery to close the hole, your baby’s lungs will take time to recover. It may be weeks or months before your infant is able to go home. Other treatments such as IV nutrition and antibiotics are often used to support your baby in the meantime.