Our Summary

This research paper examines the impact of a hernia sac in cases of congenital diaphragmatic hernia (CDH), a birth defect that causes an opening in the diaphragm, allowing abdominal organs to move into the chest and interfere with lung development.

The researchers looked at 200 cases of CDH from 2008 to 2017, finding that 23% of these cases involved a hernia sac. They found that the presence of a hernia sac was associated with better outcomes for the baby after birth.

Specifically, the babies with a hernia sac had higher lung volumes, as measured by ultrasound and MRI scans, compared to those without a hernia sac. After birth, these babies also had shorter stays in the neonatal intensive care unit, needed mechanical ventilation for less time, and had lower rates of pulmonary hypertension, a type of high blood pressure that affects the arteries in the lungs.

They also found that a hernia sac could be identified prenatally in almost half of the cases, suggesting that its presence could be used to improve the diagnosis and management of CDH. However, they stressed that care should still be provided at specialized neonatal centers experienced in treating this condition.

FAQs

  1. What is a congenital diaphragmatic hernia (CDH) and what impact does a hernia sac have on it?
  2. How does the presence of a hernia sac affect the outcomes for babies with CDH after birth?
  3. Can a hernia sac in cases of CDH be identified prenatally and how can this improve the diagnosis and management of the condition?

Doctor’s Tip

One helpful tip a doctor might tell a patient about congenital diaphragmatic hernia repair is to ensure that they seek care from a specialized neonatal center experienced in treating this condition. This is important for ensuring the best possible outcomes for the baby after birth. Additionally, the presence of a hernia sac in cases of CDH may be associated with better lung development and outcomes, so it is important to discuss this with the medical team and consider any implications for the treatment plan.

Suitable For

Patients with congenital diaphragmatic hernia (CDH) who are recommended for repair typically include those with a hernia sac, as this has been shown to be associated with better outcomes for the baby after birth. Additionally, patients with CDH who are diagnosed prenatally and are being managed at specialized neonatal centers experienced in treating this condition are also recommended for repair. These patients may exhibit higher lung volumes, shorter stays in the neonatal intensive care unit, reduced need for mechanical ventilation, and lower rates of pulmonary hypertension, all of which are positive prognostic indicators for CDH repair.

Timeline

Before congenital diaphragmatic hernia repair:

  • Prenatal diagnosis of CDH, possibly including identification of a hernia sac
  • Monitoring of fetal lung development and planning for delivery at a specialized neonatal center
  • Immediate postnatal care and stabilization, often requiring mechanical ventilation and other supportive measures
  • Evaluation of the hernia sac and its impact on lung development
  • Surgical repair of the diaphragmatic hernia, often involving repositioning of abdominal organs and closure of the opening in the diaphragm

After congenital diaphragmatic hernia repair:

  • Monitoring of lung function and recovery post-surgery
  • Continued care in the neonatal intensive care unit, including respiratory support and monitoring for complications such as pulmonary hypertension
  • Follow-up care and monitoring for long-term effects on lung function and development
  • Potential need for additional surgeries or interventions to address any complications or ongoing issues related to the CDH

Overall, the presence of a hernia sac in cases of CDH appears to be associated with better outcomes in terms of lung development and postnatal recovery. Identifying and understanding the impact of the hernia sac in CDH cases can help improve diagnosis, management, and outcomes for affected babies.

What to Ask Your Doctor

Some questions a patient should ask their doctor about congenital diaphragmatic hernia repair include:

  1. What is the overall prognosis for my baby with congenital diaphragmatic hernia?
  2. How common is the presence of a hernia sac in cases of CDH, and what impact does it have on outcomes?
  3. Can a hernia sac be identified prenatally through imaging tests, and how does this information affect treatment planning?
  4. What are the potential benefits of repairing a hernia sac during surgery for CDH?
  5. What are the potential risks or complications associated with hernia sac repair?
  6. What is the expected recovery process for my baby after undergoing surgery for CDH with a hernia sac?
  7. Will my baby need ongoing monitoring or follow-up care after surgery for CDH with a hernia sac?
  8. Are there any long-term implications or concerns related to having a hernia sac repaired during CDH surgery?
  9. What are the recommended next steps or treatment options if a hernia sac is not present in cases of CDH?
  10. Can you provide more information about the specialized neonatal centers or healthcare providers experienced in treating CDH that you recommend for my baby’s care?

Reference

Authors: Oliver ER, DeBari SE, Adams SE, Didier RA, Horii SC, Victoria T, Hedrick HL, Adzick NS, Howell LJ, Moldenhauer JS, Coleman BG. Journal: Pediatr Radiol. 2019 May;49(5):593-599. doi: 10.1007/s00247-018-04334-9. Epub 2019 Jan 11. PMID: 30635693