Common CDH Issues

*Bowel Obstruction -A bowel obstruction happens when either your small or large intestine is partly or completely blocked. The blockage prevents food, fluids, and gas from moving through the intestines in the normal way.

What causes a bowel obstruction?
Tumors, scar tissue (adhesions), or twisting or narrowing of the intestines can cause a bowel obstruction. These are called mechanical obstructions.

*Malrotation of the Bowels- is twisting of the intestines (or bowel) caused by abnormal development while a fetus is in utero, and can cause obstruction.

*Chronic lung disease- Chronic lung disease is a condition in which damaged tissue in a newborn baby's lungs causes breathing and health problems. The lungs trap air or collapse, fill with fluid, and produce extra mucus.

What are the symptoms?

►Difficulty breathing.
► Grunts or breathes rapidly.
► Flares the nostrils.
► Uses the neck, chest, and abdominal muscles to breathe. This can look like your baby is "sucking in" air   between or under the ribs (retractions).
► Wheezes, which is a high-pitched sound that occurs with breathing.
► Tires easily during and after feeding.
► Has pale, gray, or blotchy skin, especially on the tongue, lips, earlobes, and nail beds.

(Lung problems may include the inability to wean off the ventilator, the need for supplemental oxygen, chronic lung disease, persistent pulmonary hypertension and asthma.)

*Developmental delay- There are many different types of developmental delays in infants and young children. They include problems with:

► language or speech
► vision
► movement -- motor skills
► social and emotional skills
► thinking -- cognitive skills

*Gerd or Reflux-  is the result of acidic stomach contents moving backward into the esophagus. This can happen because the muscle that connects the esophagus with the stomach (the esophageal sphincter) relaxes at the wrong time or doesn't properly close.

Gastroesphogeal reflux or "heartburn" is common in babies with CDH and often treated effectively with medicine. However, some babies may require a separate operation (Nissen fundoplication) to treat the reflux.

*Gatroparesis- Gastroparesis is a condition in which the muscles in your stomach don't function normally.

Ordinarily, strong muscular contractions propel food through your digestive tract. But in gastroparesis, the muscles in the wall of your stomach work poorly or not at all. This prevents your stomach from emptying properly. Gastroparesis can interfere with digestion, cause nausea and vomiting, and cause problems with blood sugar levels and nutrition.

There is no cure for gastroparesis. Making changes to your diet may help you cope with gastroparesis signs and symptoms, but that's not always enough. Gastroparesis medications may offer some relief, but some can cause serious side effects.

*Growth Failure, also known as "Failure to thrive"- is when any of the following occurs:
weight less than the third percentile on a standard growth chart
weight 20% below the ideal weight for height
fall off from a previously established growth curve.
Babies who are failing to thrive should be carefully assessed to find a cause for their growth failure. They may need extra calories to catch up in their growth. These babies will also need to be followed closely by their paediatrician or family doctor.

Feeding difficulties are common, and many babies need supplemental feeding through a tiny tube in their nose or a gastrostomy tube (a feeding tube placed into the stomach). Despite supplemental feeding, some babies still have a difficult time gaining weight, especially in the first year of life.

*Oral aversion- Reluctance or refusal to feed or eat.

*Hearing loss- from ECMO or from high powered antibiotics and medications.

*Reherniation of the diaphragm- Also called Recurrence of the Diaphragm ( Reherniation happens after a CDH child is repaired by surgery.) The diaphragm or patch used as a diaphragm fails enabling organs to migrate back up into the chest causing breathing issues or causing a bowel obstruction.

*Eventration of the diaphragm- abnormal elevation of the diaphragm. The diaphragm extends into the lung area causing breathing difficulties.

(Eventration is different that reherniation. In a reherniation a hole or break in the diaphragm is seen. In an eventration of the diaphragm the muscle riding high in the area of the lungs. This is why the lungs show signs of distress during an eventration. Surgery will need to be done if the signs of distress are too great. The surgeons will put the diaphragm back down where it belongs allowing the lungs their full capacity.)

*Musculoskeletal deformities- Scoliosis is a medical condition in which a person's spine is curved from side to side. Although it is a cheomplex three-dimensional deformity, on an X-ray, viewed from the rear, the spine of an individual with scoliosis may look more like an "S" or a "C" than a straight line.

*Oxygen Dependant- the need for oxygen.

*Reactive airway disease- it is also called Asthma. Children may suffer from one or more symptoms of reactive airway disease. The most common symptom is wheezing which occurs when the air passes through the narrow airways. The breathing becomes fast and shallow, accompanied by dry cough. Children may also suffer from what is known as chest retractions. This occurs when the child breaths and he has the sensation of his skin being pulled in between ribs. Other symptoms which the children suffer from are cough and nostril flaring. (Buzzle)

*Neurological problems such as Seizures-  A seizure occurs when a large number of the cells send out an electrical charge at the same time. This abnormal and intense wave of electricity overwhelms the brain and results in a seizure, which can cause muscle spasms, a loss of consciousness, strange behavior, or other symptoms.