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What to Expect Before Your Baby is Born
When a baby has CDH, most women can have a vaginal delivery, unless other medical reasons require a cesarean delivery.
Babies with CDH are at higher risk of having problems with their lungs and having trouble breathing. They may need specialized treatment as soon as they are born. One kind of treatment is called ECMO (extracorporeal membrane oxygenation), a heart-lung bypass machine that performs the work of the heart and lungs so they have time to rest or grow. Even babies whose prenatal imaging looks good will need highly specialized care in an experienced neonatal intensive care unit (NICU).
We recommend that all babies with CDH be delivered in a center with a team who is experienced in taking care of the most critically ill newborns. This is important because a transfer to another hospital could be life-threatening transfer.
Delivery at a center like Texas Children’s Pavilion for Women provides for the best possible outcomes, because the mother and baby can receive expert care in one comprehensive location. We have a level IV NICU (the highest level), and babies delivered at Texas Children’s have immediate access to pediatric surgical care as soon as they are born. Our expert doctors and surgeons are well-equipped to manage a high-risk delivery and provide the specialized care these babies need. Texas Children’s also offers small, family-centered classes to help families prepare for their newborn’s hospitalization after they are born
For babies with CDH, their delivery and the care they receive after they are born need to be carefully planned and coordinated. At Texas Children’s, every member of our team of maternal-fetal medicine specialists, neonatologists and pediatric surgeons is highly experienced. They work together to provide the very best care for babies with CDH.
Treatment after Birth
After your baby is born, a breathing tube will be placed, along with a tube through the mouth or nose into the stomach, to decompress the intestines within the chest so the lungs can expand. Until the hernia is corrected through surgery, your baby will need intravenous nutrition.
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 and afterwards is uncertain.
At Texas Children’s, our neonatologists and pediatric surgeons specialize in the treatment of newborns across the full spectrum of CDH, from medications to treating pulmonary hypertension, to high-frequency oscillatory ventilators, to ECMO.
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 surgery, an incision is made in the diaphragm 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 so than any excess fluid can flow out of the baby’s chest to help the lungs expand.
Following surgery to close the hole, it will take time for your baby’s lungs 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.