Congenital diaphragmatic hernia (CDH)

Congenital diaphragmatic hernia (CDH) CDH has an incidence of 1/2000 live births. Its a defect in the diaphragm that allow herniation of abdomin content into thoracic cavity lung development depend on the size of defect and gestational age at occurance. It is an important condition because despite improvements in neonatal care reported, mortality rates remain high The majority of such defect is left side , prenatal diagnosis, usually made at the 20th week anomaly scan; in some babies In babies where there is a prenatal diagnosis most neonatologists manage these babies with immediate intubation, insertion of a large bore nasogastric (NG) tube to decompress the stomach and bowel and early sedation/muscle relaxation

its try to allow the underdeveloped lungs to expand and to try to prevent significant problems with persistent pulmonary hypertension and continual right-to-left shunting of blood through the foramen ovale and ductus arteriosus A surgical repair of the diaphragm will usually be performed at 2–7 days after birth. In all babies presenting with respiratory distress a chest X-ray is important to look for the cause, and one of the possibilities that can be recognized is a CDH. chest x ray is confirmed diagnosis

Babies with this condition typically have : unilateral chest movement heart sounds and an apex beat on the right side (in the case of left-sided CDH, which is more common) a scaphoid abdomen

Upper airway obstruction and stridor Upper airway obstruction in the newborn is uncommon but is characterized by : noisy breathing on inspiration, different to grunting, which is an expiratory noise. The importance is that obstruction to the upper airway significantly increases the work of breathing for a newborn, and in the short term, in the most severe cases, this could lead to respiratory arrest. Babies with stridor therefore always need neonatal medical assessment.

There are many possible causes, the commonest being laryngomalacia, the work of breathing may increase when the baby is placed on his/her back. External compression of the trachea is a serious condition, so any baby with stridor must always be carefully assessed by a neonatologist

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