Depending on the type of CDH and the severity of the case, the treatment can be different. There are some procedures that can be performed even in utero. Of course, the best thing that you can do is speak with your child’s doctor to see what treatment option is ideal for your situation. But if you are looking into having more information about CDH treatments overall, that’s what I’m here for. Also keep in mind that the protocols are going to be different between hospitals and offices. Since the condition can be so delicate, there are often different approaches to the same type of CDH.
General Common Treatments
Because of the pulmonary hypertension and/or pulmonary hypoplasia, babies with CDH need to be oxygenated first to ensure that they do not go into respiratory distress. It is important that it is caught early to make sure that there is no side effects more serious than what you are already dealing with.
In labor and delivery, if they already know that the baby has CDH or if they see the signs immediately after birth, they will quickly put in a vented orogastric tube and attach it to continuous suction in order to prevent any bowel distension and any other lung compression that could be happening.They will also usually avoid mask ventilation and intubate in the trachea to open a pathway for resuscitation.
Depending on the type of CDH that your baby has, surgery may be one method of intervention. If the diaphragm can be repaired, they will repair it to help keep the things from the abdomen moving to the chest. If the lungs are developmentally immature as a result of the compression, the baby will need to be on a ventilator to keep the lungs from collapsing.
After Birth Treatments
Even after the baby has been released, babies and children with CDH are prone to illnesses. It is important that people who are CDH survivors maintain optimal health and receive all vaccines that are available for the various age groups. Something like whooping cough or measles can absolutely be fatal to someone who was born with CDH. Children will need continuous oxygen, blood pressure, and perfusion monitoring. Suctioning is also a good idea to help reduce handling and invasive procedures.
In some cases, blood pressure levels will need to be maintained by using volume expansion and inotropic agents. The blood needs to be able to circulate well in order to keep oxygen flowing to the brain and all of the vital organs. If there is an issue with the lungs, which means that the oxygen is not going to be taken in by the lungs to be circulated throughout the entire body. Because of this, people who survive CDH may need constant respiratory aids, including oxygen tanks, depending on the type and the severity of CDH that they are dealing with.
Something that was pretty common in the past was alkalinization. It made it possible to create rapid pulmonary vasodilation. The same result can happen with hyperventilation to induce hypocarbia or by using alkali infusions. That said, they were never able to conclusively prove that this type of therapy actually worked as well as they wanted so using them is completely controversial.
By contrast, inhaling nitric oxide has completely changed the treatment of CDH, but at the same time it has not been shown to be a good treatment for newborns so is also controversial. The ECMO is still needed either way and nitric oxide has not been shown to reduce the mortality rate.