Monday, August 3, 2009

Good info worth posting

I found this information about CDH through another blog. This is about the actual CDH surgery, the before and after. This information was found on the American Pediatric Surgical Association Website (http://www.eapsa.org/parents/resources/diaphramaticHernia.cfm) and thought it explained what would be going on without too much technical jargon. I'm not posting this to scare anyone. I just hope it'll sort of explain why I worry and maybe help some realize why I can be so excited and scared and nervous at the same time!! Every single baby with CDH has this basic outlook for before and after surgery.


BeforeSurgery All newborns with CDH require surgery; however, the timing of the operation may be different for different babies. In the past, people thought that the babies needed an operation immediately, but it now looks like that is not necessary. The operation may make the lungs worse because it can put pressure on the good lung. This is usually a problem for just a short time. Before surgery, the baby will usually have a tube going into the stomach and catheters in an artery and vein. The infant will be on a mechanical ventilator and most hospitals will try to keep the amount of pressure on the lungs from the ventilator as low as possible. This is to avoid injuring the very small lungs. The amount of oxygen in the baby’s blood will be watched constantly, usually with a device (pulse oximeter) on the hand or foot. The baby may need medicines to keep the blood pressure normal. In some hospitals, the baby may have a different ventilator that works very fast to breathe for the infant (a high frequency ventilator). If the baby does not keep the blood oxygen level high enough with these devices, heart lung bypass (ECMO) may be used for several days to weeks. This can only be done in very specialized centers and the infant may be transferred to a center that does ECMO. The baby will usually have surgery after the situation is stable. It may be days or weeks before an operation is done. If the baby is on ECMO, the infant may have the surgery while on the ECMO machine. The operation may make the lungs worse initially. This is because the intestines are put back into the abdomen and cause pressure on the lungs from below.

After Surgery After the operation, the baby will still be on a mechanical ventilator. Depending on how big the hole in the diaphragm is, the baby may need to be on a ventilator for days or weeks. The baby will be started on feedings as soon as the intestines start working, but this may take some time. Also, babies with CDH usually have some form of reflux of stomach contents into the esophagus (GERD) and this may make the feeding more difficult.Infants with CDH are usually in the hospital for weeks to a few months after the diaphragm is fixed. This mostly depends on how sick the baby is and how small the lungs are. After the baby goes home, they will be followed closely to make sure the hernia doesn’t recur. This can happen quite often, especially in babies with a patch repair of the diaphragm. This is because the baby will be growing, but the patch can’t, so the patch may slowly pull away.

1 comment:

  1. Hi Chanda,
    Love your little girls name, it's so pretty. We are thinking about you and hoping that everything goes well until your induction. Stay positive, girls are fighters and yours will do great.
    Hugs from the UK.

    ReplyDelete