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Congenital Diaphragmatic Hernia (CDH)

With congenital diaphragmatic hernia (CDH), organs in your baby’s belly can get pushed up to their chest, affecting their lung development and ability to breathe at birth.  

At our Center for Fetal Care, our fetal surgeons offer minimally invasive procedures to treat CDH while your baby is in the womb to help their lungs develop properly before birth. Our neonatal and pediatric surgery teams have specialized expertise in providing care for babies with CDH at delivery and after birth. 




What is congenital diaphragmatic hernia (CDH)?

Congenital diaphragmatic hernia occurs when a baby is born with an opening in the muscle wall separating the chest and abdomen (belly). This hole in the diaphragm develops early in a pregnancy as a baby grows in the womb.

Organs such as the intestines, stomach and liver can push through the hole into the chest cavity, crowding the lungs during development.  Initially, that’s not a problem, as the placenta provides oxygen. But without enough space for the lungs to grow properly, babies can have difficulty breathing independently after birth.

What causes congenital diaphragmatic hernia?

The causes of CDH aren’t fully understood. Research shows that some cases are related to mutations (changes) in one or more genes.

What are the symptoms and signs of congenital diaphragmatic hernia?

The effects of CDH often show up on routine ultrasounds for prenatal care. These signs include:

  • Excess amniotic fluid (liquid surrounding the baby in the protective membrane)
  • Presence of abdominal organs in the chest
  • Compression and impact on developing lung tissue
  • Shifting of the heart in the chest

How is Congenital Diaphragmatic Hernia (CDH) diagnosed?

High resolution imaging is the gold standard for diagnosing CDH before birth.  Scans show lung size and organ compression.   This information helps Dr. Mehra and his team determine the next steps.  Recommended imaging may include: 

A genetics consultation and evaluation may also be recommended. 

What treatments are available for congenital diaphragmatic hernia?

Treatment recommendations  are primarily based on your baby’s lung development.  To optimize your baby’s lung function and development after delivery, our fetal surgeons may recommend minimally invasive fetal surgery.

Fetal surgery for congenital diaphragmatic hernia

Before birth, your baby's lungs produce fluid that exits through the mouth. Blocking this flow keeps the fluid inside the lungs, helping them expand and grow so they can eventually provide enough oxygen. 

Dr. Mehra accomplishes this goal with a procedure called fetoscopic endotracheal occlusion (FETO).  In this procedure, a thin scope (flexible tube with a camera and light) is inserterd through a small incision in the mother's belly.  Using ultrasound guidance, a tiny balloon is placed your baby's windpipe, temporarily blocking the fluid's escape. 

Surgeons remove the balloon several weeks later before delivery, when your baby's lungs have developed more. 

Congenital diaphragmatic hernia follow-up care

After surgery, our pediatric specialists provide ongoing care to manage any persistent pulmonary concerns.  Dr. Mehra and team will also help you partner with approprite pediatricians highly skilled in caring for little ones with CDH.

If your baby is diagnosed with CDH, contact Dr. Mehra to learn more about how he and his team can help manage and treat this condition.