Posterolateral diaphragmatic defects are called Bochdalek hernias. Anteromedial
defects, which are less common, are eponomously called Morgagni hernias.
Posterolateral hernias are usually associated with the more physiologic challenges.
During fetal development, both hollow and solid organ compression on the
developing lung can result in anatomic changes. First, there is less segmental bronchi
and alveolar units in the contralateral lung. The media of the pulmonary arteries are
much thicker compared to “normal” pulmonary arteries. There is usually mediastinal
shift. In a baby with CDH, the uninvolved lung still has these changes compared to the
”normal” baby.
Currently, babies with CDH are prenatally diagnosed. Babies are recommended
to be delivered in a facility that has capability to provide full cardiorespiratory support
including ECMO. In the delivery room, there is a variable respiratory distress. The
abdomen may be scaphoid. Other signs include bowel sounds are in the chest, with
decreased or absent breath sounds on the affected side.
In the delivery room, the baby may require small amount of oxygen by nasal
cannula or, more often, intubated. An orogastric tube should be placed to decompress
the air collected in the stomach.