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Prenatal Treatment for Congenital Diaphragmatic Hernia

How is CDH diagnosed?

prenatal ultrasound shows that abdominal organs have moved into the chest area. When CDH is suspected, patients are often referred to a maternal-fetal specialist for further care and evaluation. Maternal-fetal medicine physicians affiliated with The Fetal Center at Children’s Memorial Hermann Hospital may recommend other tests, including fetal MRI and fetal echocardiogram to assess the severity of the condition. They may also recommend amniocentesis to identify possible chromosomal abnormalities.

During pregnancy, maternal-fetal medicine specialists monitor mother and baby to ensure that the baby develops appropriately in the uterus. The Fetal Center team works closely with families to determine the best course of treatment before and after delivery. This includes affiliated pediatric surgeons and affiliated neonatologists, as well as genetic counselors. A dedicated nurse coordinator keeps mothers in contact with all of the appropriate physicians and specialists and coordinates all aspects of care. Families are educated on CDH as well as its treatment options and possible outcomes.

Will a fetal treatment be required?

Treatment for babies diagnosed with CDH has traditionally focused on care after delivery. Fetal treatment is not required for babies in utero diagnosed with the condition; however, for the most severe cases of CDH, The Fetal Center offers a fetal surgery procedure as a treatment option before birth.

In an ongoing effort to provide optimal care to patients, The Fetal Center and its affiliated physicians have been granted FDA and institutional approval to offer Fetoscopic Endoluminal Tracheal Occlusion (FETO) intervention, a procedure being studied as part of a clinical trial – the Tracheal Occlusion to Accelerate Lung Growth (TOTAL) trial – to treat babies diagnosed with CDH before birth. Based on early results of the international trial, the FETO procedure may improve outcomes in babies with the most severe forms of CDH. FETO involves placing a balloon in the baby’s airway, causing a backup of fluid produced by the lungs. As the fluid builds, lung growth and development is promoted. The Fetal Center is one of seven sites in the United States selected to participate in the international TOTAL trial for the prenatal treatment of severe CDH. The Fetal Center is now accepting patients for evaluation as study participants.

Fetal surgeons at Children’s Memorial Hermann Hospital and McGovern Medical School have extensive experience in fetoscopic intervention – more than 500 fetoscopic cases to date. For more information about the FETO trial and CDH care at Children’s Memorial Hermann Hospital, visit childrens.memorialhermann.org/FETO-trial. To refer a patient or speak to a clinical consultant, please call (832) 325-7288 or email thefetalcenter@memorialhermann.org.

What special considerations should be made for delivery?

  • Type of delivery - The delivery plan should be carefully pre-arranged and discussed between the mother and her obstetrician. A vaginal delivery is recommended for most babies with CDH.
  • Place of delivery - The baby should be delivered at a hospital that is well prepared to handle the intensive care and surgery required of infants with CDH.  Children’s Memorial Hermann Hospital is equipped with a Level IV neonatal intensive care unit with the capability to provide specialized care such as extracorporeal membrane oxygenation (ECMO) similar to a heart-lung bypass, special mechanical ventilation, and 24/7 pediatric surgical services.
  • Time of delivery - There is no reason to intentionally induce early delivery. Most babies will benefit from reaching full gestational maturity.
  • Specialized delivery -  A special birth plan involving a procedure known as “EXIT-to-ECMO” may be performed in rare cases, reserved for the most severe cases of CDH. EXIT-to-ECMO is a procedure that transitions the baby from placental oxygenation to ECMO support. The potential advantage of this procedure is avoiding lung injury from high ventilator settings with a smooth transition from the womb to life after delivery. Our ECMO team is on stand-by for birth of every severe CDH patient.