Saturday, March 25, 2017

Long Term CDH Complications

Not all CDH babies are the same. Each one handles treatment differently. There are many factors to consider for treatment. Babies who had a more severe diaphragmatic hernia may face challenges which can include learning problems, breathing issues, hearing loss and growth problems. Some CDHers have long term or even life long complication.

Some of these complications can include:

*CDH Recurrence- when the diaphragmatic hernia opens up again and needs to be repaired.
*Respiratory Issues- Often times CDHers lungs are underdeveloped due to the abdominal organs being in the chest cavity not giving the lung space to grow. This is called lung hypoplasia. Some children require oxygen. Some children fatigue easily with exercise or have respiratory problems such as asthma that improve with breathing medications.

*RSV- a common cold virus that infects many people. Children born with CDH don't have normal lung development and are very susceptible to RSV. Many end up in the hospital and on oxygen when they contract RSV.

*Pulmonary Hypertension- constricted blood flow to the lungs. It's common in babies with CDH and can persist beyond a few weeks to many months after birth.

*Gastrointestinal issues

*Nutrition and oral aversion- because it takes so much for CDHers to breathe and they tire easily, it is difficult for them to take in everything they need by mouth. In those cases, a feeding tube would be placed.

*GERD- It is common for CDHers to suffer from GERD where their stomach contents reflux into the esophagus. This is treated with acid reflux meds. In severe cases they undergo a fundoplication surgery to stop the reflux.

*Abdominal pain and appendicitis- CDHers don't have the typical intestine flow because their intestines are up in the chest cavity or jumbled up. Surgeons can only place them back into the abdomen and let them work themselves out. It's important to know this in the event your child develops abdominal pain and a appendicitis is suspected. It's important to  know where the appendix is located because it might be in a different spot than is typical.

*Constipation- It's unknown why CDHers suffer constipation frequently but it can be treated with laxatives.

*Bowel Obstruction- During repair surgery the organs have to be manually put back into the abdomen. This can cause scar tissue or adhesions within the abdomen that can kink the bowel. The kink can block the flow of liquids in the intestines called a bowel obstruction.

*Problems with skeletal development

*Scoliosis- CDHers can develop a curve in the spine as they grow. This could be related to differences in lung size on the two sides of the chest.

*Pectus chest wall deformity- CDHers  may develop a depression of the sternum.

*Hearing loss- babies who have been intubated on a ventilator with oxygen, received multiple meds, or were on ECMO are at risk for hearing loss. Regular hearing loss is advised.

*Developmental delay- children who have been ill and hoapitalized for prolonged periods are at risk for delay in normal development. It's important to identify developmental delay early.

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