Thousands of children are born every year with a Bochdaleck hernia. While this is an excruciatingly frightening time for the parents and family members of these newborns, it is also a time during which they need to remain calm and focus. Planning the course of Bochdaleck hernia treatment depends on a number of variables and parental input is one of them.
Facts
Bochdaleck hernias occur during fetal development. An opening develops in the diaphragm resulting in either the intestines or the stomach protruding through the hole into the thoracic cavity. Bochdaleck hernias are a form of congenital diaphragmatic hernias and occur an average of once per every 2,500 births according to the Association of Congenital Diaphragmatic Hernia Research, Awareness and Support (CHERUBS). 50 percent of these babies die. According to the Centers for Disease Control and Prevention (CDC), 85.3 percent of these newborns are immediately classified as high risk.
Symptoms
The Bochdaleck hernia may be discovered during an ultrasound before birth. In other instances, the congenital diaphragmatic hernia is not discovered until the baby is born. Symptoms of the hernia include difficulty breathing, blue tinged skin, blue tinged lips, rapid breathing and an abnormally increased heart rate. The abdominal region may appear to be sunken in while the chest area is enlarged. The hernia is confirmed through physical examination and x-ray. The heart may be compromised and the lungs in newborns diagnosed with Bochdaleck hernia tend to be underdeveloped.
Planning
Treatment of Bochdaleck hernia begins immediately after birth and is determined by a number of factors. Diagnosing while the fetus is in-utero allows doctors to conduct further testing to determine the gravity of the situation. The medical staff and parents will have time to prepare for the risky birth. The severity of the Bochdaleck hernia dictates how soon surgery can be performed or if any treatment should be attempted. The baby's overall health and medical history, albeit brief, are also factors in determining when (or, sadly, if) treatment will begin. Doctors and nurses will monitor the baby to judge the baby's tolerance to medications and procedures, and first and foremost, the parents' wishes are considered.
Treatment
Babies are born with Bochdaleck hernia who are in stable condition, and generally good health, are taken to surgery immediately. Some newborns are taken to the neonatal intensive care unit (NICU) and kept on a ventilator until they stabilize. Babies in extremely critical condition are put on an ECMO machine, this is a heart and lung bypass machine.
Surgery
Bochdalek hernia repair surgery is performed once the baby has stabilized. The baby's internal organs, stomach and intestines, are carefully put where they belong. The lungs are often displaced or underdeveloped due to the intruding organs. The heart may also be affected by the displacement of the other organs.
Considerations
The babies who survive Bochdaleck hernias often suffer from failure to thrive, developmental delays, hearing loss, gastrointestinal conditions, chronic lung disease, need oxygen for a while and have to take medications for years before living a normal life.
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