Prenatal Treatment for Congenital Diaphragmatic Hernia
How is CDH diagnosed?
Diagnosis of CDH usually occurs in the second trimester, when a routine 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) to treat babies diagnosed with severe CDH before birth. FETO intervention, a minimally invasive fetoscopic procedure performed during pregnancy, 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.
Patients undergoing FETO intervention at Children’s Memorial Hermann Hospital will participate in The Fetal Center’s feasibility study, aimed to demonstrate the Center’s ability to safely insert and remove the FETO device in severe CDH fetuses. Upon completion of the feasibility study, The Fetal Center will move to join the Tracheal Occlusion to Accelerate Lung Growth (TOTAL) Trial. Based on early results of this international, multicenter trial, the FETO procedure may improve outcomes in babies with the most severe forms of CDH. The Fetal Center is now accepting patients for evaluation as study participants.
Affiliated fetal surgeons at Children’s Memorial Hermann Hospital and McGovern Medical School at UTHealth have extensive experience in fetoscopic intervention – having performed more than 500 fetoscopic cases to date at the facility. 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 firstname.lastname@example.org.
What special considerations should be made for delivery?
For patients with congenital diagrammatic hernia (CDH) the level of care provided at the time of delivery can be critical to patients’ long-term health. It is essential that delivery of CDH patients occurs in a hospital that is well prepared to handle the intensive care and surgery required for infants with the condition. Close proximity to pediatric surgical services and effective coordination among specialized teams is important to optimizing care for CDH babies.
The Women’s Center at Children’s Memorial Hermann Hospital, offering comprehensive labor and delivery care as well as gynecological services, is located within the same tower as the 118-bed Level IV neonatal intensive care unit. In addition to the pediatric surgical services accessible to patients 24/7 at the hospital, the multidisciplinary team of neonatal nurses, neonatologists, and transport specialists utilize state-of-the-art neonatal equipment to provide specialized care immediately after birth.
- 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 standby for birth of every severe CDH patient.
Why should I choose The Fetal Center for my child's care?
The Fetal Center at Children’s Memorial Hermann Hospital is a national referral center and an international leader in fetal diagnosis, fetal intervention and comprehensive fetal care for infants with congenital anomalies or genetic abnormalities. The affiliated physicians at The Fetal Center offer patients the full array of prenatal testing and fetal interventions through a coordinated program for both mother and baby. From the initial prenatal consultation through pediatric follow-up visits, specialists at The Fetal Center work closely with mothers, families and their referring physicians to provide evidence-based care and treatment, as well as provide support, counseling and education.
The Fetal Center Approach and Outcomes:
Home to an integrated CDH team that includes pediatric surgeons, neonatologists, pediatric anesthesiologists, pediatric sub-specialists, and maternal-fetal medicine specialists, The Fetal Center provides optimal and seamless care from prenatal diagnosis to delivery and through postnatal care. Physicians at The Fetal Center take a very aggressive approach to the management of the condition, and are one of a handful of teams in the country that operate on 93 percent of all patients, repairing the hole in the diaphragm surgically to give each child a chance of survival.
Thanks to more accurate prenatal diagnosis and the work of the International CDH Study Group and Registry, which resides at Children’s Memorial Hermann Hospital and McGovern Medical School at UTHealth, the global survival rate of infants born with CDH is steadily rising. Based on risk-adjusted data, The Fetal Center’s outcomes are in the top 10 percent or higher.
Physician researchers at The Fetal Center are faculty at McGovern Medical School at UTHealth, and are actively engaged in an intensive research program focused on the mechanisms, treatment, and cure of CDH and other fetal disorders. A national leader in research, The Fetal Center is one of only three U.S. centers to hold membership in all three key maternal-fetal research networks: the National Institute of Child Health and Human Development (NICHD) Neonatal Research Network, NICHD’s Maternal-Fetal Units (MFMU) Network and the North American Fetal Therapy Network (NAFTNet). To learn more about the Fetal Center, visit childrens.memorialhermann.org/thefetalcenter or call (832) 325-7288.