What is CDH?

4-29-2009 There have been questions about CDH so I have included this post to give people a clearer understanding of what Gabi is going to be dealing with. We also have included a couple of links to websites and videos that will provide helpful information. This info was collected from the CHOP website.

Overview of Congenital Diaphragmatic Hernia (CDH)

Congenital Diaphragmatic Hernia (CDH) occurs in about one in every 2,500 live births. Absence of the diaphragm may occur on the left, right or both sides, but the absence on the left side is most common. There is a wide discrepancy between the “visible” mortality from congenital diaphragmatic hernia reported from children's centers, which treat only those infants who survive gestation, birth, resuscitation, transport and often major surgery, and the true mortality for congenital diaphragmatic hernia, based on all prenatally diagnosed cases, which has been called the “hidden mortality” of Congenital Diaphragmatic Hernia (CDH).

Evaluation of congenital diaphragmatic hernia (CDH)

While the majority of congenital diaphragmatic hernias are isolated, further (careful) fetal evaluation is needed to rule out other birth defects as well as chromosomal anomalies, since they may adversely affect the outcome.

Important prognostic predictors (for survival of congenital diaphragmatic hernia) include the degree of fetal liver herniation into the chest and the presence or absence of other anomalies. The lung-to-head circumference ratio (LHR) is an ultrasound-based measurement of the contralateral lung area taken at the level of the 4-chamber view of the heart. The measurement is corrected for gestational age using the head circumference. Values less than 1.0 are considered severe, and are associated with increased morbidity and an increased need for extracorporeal membrane oxygenation (ECMO).

Prenatal evaluation of congenital diaphragmatic hernias consists of a Level II ultrasound, an ultrafast fetal MRI, fetal chromosome studies, and a fetal echocardiogram. As soon as the results of these diagnostic tests are reviewed, a pediatric surgeon and an obstetrician skilled in prenatal diagnosis will meet with you and your family to discuss prenatal management, delivery, and postnatal treatment options. You will also receive educational information about congenital diaphragmatic hernia and a tour of the Newborn/Infant Center, which offers high frequency ventilation, nitric oxide, liquid ventilation and Extracorporeal Membrane Oxygenation (ECMO).

Treatment options for congenital diaphragmatic hernia (CDH)

Whether a family chooses to terminate the pregnancy or carry to term for postnatal management, accurate counseling regarding the expected outcome is crucial. For congenital diaphragmatic hernia fetuses with chromosomal anomalies, survival is rare.

Postnatal management strategies for congenital diaphragmatic hernia include planned delivery, immediate stabilization, and immediate access to specialized ventilation techniques including nitric oxide and ECMO. In rare cases, a specialized delivery technique, known as the Ex Utero Intrapartum Treatment (EXIT) procedure, which offers immediate ECMO cannulation, may be an option.


LINK to Video that is very informative. Most of the people in the video are people that we have met and will be helping Gabi beat this defect.  
---->  http://www.chop.edu/fetalsurgery/everything_in_place/index.html">http://www.chop.edu/fetalsurgery/everything_in_place/index.html

Link to helpful websites:

Childrens Hospital of Philadelphia (CHOP) --> http://www.chop.edu/consumer/jsp/division/generic.jsp?id=81164Cherubs'>http://www.chop.edu/consumer/jsp/division/generic.jsp?id=81164">http://www.chop.edu/consumer/jsp/division/generic.jsp?id=81164
Cherubs --> http://www.cdhsupport.org/">http://www.cdhsupport.org/  We have met a lot of very supportive people through Cherubs, thank you all for your continued support and prays for Gabi.