Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + • 1/2000 to 1/5000 births• 33% with associated congenital defects, including neural tube defects and cardiac defects• 80% are left-sided; 20% are right-sided• Right side, hepatic veins may drain ectopically into right atrium• 10-20% present after first 24 hrs• Associated with pulmonary hypoplasia on affected side +++ Symptoms and Signs + • Dyspnea• Chest retractions• Decreased breath sounds on affected side• Polyhydramnios prenatally (80%)• Cyanosis• Scaphoid abdomen +++ Laboratory Findings + • Respiratory acidosis +++ Imaging Findings + • Prenatal US: Accurate in 40-90% of cases showing herniation of abdominal contents in thorax• Chest film: Herniation of abdominal contents into thorax and associated pulmonary hypoplasia with occasional compression of mediastinum away from affected side + • Cardiac and neural tube defects +++ Rule Out + • Associated neural tube or cardiac defects + • History and physical exam• Chest x-ray• ABG measurements• Echocardiogram• US for neural tube defects +++ Surgery +++ Indications + • Primary repair or using mesh once respiratory status has been stabilized and optimized +++ Medications + • Mechanical ventilation if necessary• NG decompression• High frequency oscillatory ventilation if necessary• Extracorporeal membrane oxygenation (ECMO) if necessary +++ Complications + • Chronic lung disease• Skeletal muscle abnormalities• Acute respiratory failure postoperatively• Developmental delay• Growth delay +++ Prognosis + • 39-95% survival +++ Prevention + • In utero intervention under investigation but not yet consistently beneficial +++ References ++Congenital Diaphragmatic Hernia Study Group: Defect Size determines survival in infants with congenital diaphragmatic hernia. Pediatrics 2007;120:3651. ++Dutta S, Albanese CT: Use of a prosthetic patch for laparoscopic repair of Morgagni diaphragmatic hernia in children. J Laparoendosc Adv Surg Tech A 2007;17:391. [PubMed: 17570796] ++Harrison MR et al: A randomized trial of fetoscopic tracheal occlusion for severe fetal congenital diaphragmatic hernia. New Engl J Med 2003;349:1916. [PubMed: 14614166] Your MyAccess profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth