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The Fetal Center
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Congenital Diaphragmatic Hernia (CDH), a condition that affects approximately 1,000 babies born each year, results from the abnormal development of the diaphragm, the muscle that separates the organs in the abdomen from the organs in the chest. The abnormal development of the diaphragm, occurring before birth, causes a hole in this muscle that helps control breathing and is linked to the development of the lungs. CDH may range from a small hole, or hernia, to the complete absence of the diaphragm.
An absent or partially formed diaphragm allows the stomach and intestines to move into the chest cavity during pregnancy and crowd the baby’s heart and lungs. This can lead to compression and underdevelopment of the lungs (pulmonary hypoplasia), and potentially life-threatening breathing difficulties after birth. CDH may also cause high blood pressure in the arteries of the lungs (pulmonary hypertension), requiring the baby’s heart to work harder to pump blood to the arteries. Over time, the heart may weaken, resulting in heart failure. Many infants with CDH may have other complications, such as developmental problems with the brain, kidneys and bowel. The exact cause of CDH is unknown.
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.
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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.
Children’s Memorial Hermann Hospital and the McGovern Medical School at UTHealth operate the only long-term multidisciplinary follow-up clinic dedicated to congenital diaphragmatic hernia (CDH) in the southwestern United States. Staffed by a team of CDH experts skilled at meeting each child’s specific needs, the clinic offers parents the convenience of seeing every involved specialist in a single visit under one roof. It also gives doctors the opportunity to collect data and better understand the challenges faced by families of children with CDH.
Physician researchers at The Fetal Center and the Department of Pediatric Surgery are faculty at UTHealth’s McGovern Medical School, 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). The Fetal Center participates in ongoing research trials to advance medicine in the treatment of CDH and other conditions, with the goal of improving patient outcomes.
In addition, physicians within the division of General and Thoracic Pediatric Surgery are internationally recognized for providing state-of-the-art neonatal critical care and minimally invasive surgical repair of CDH. The care they provide is based on data collected and new insights gained through the international Congenital Diaphragmatic Hernia Study Group and the CDH Registry, which reside at the hospital and medical school. In the 20 years that have passed since the CDH Study Group was founded by physicians affiliated with Children’s Memorial Hermann Hospital, the voluntary collaborative has gathered data on more than 9,500 babies with diaphragmatic hernia. The registry now represents centers in 14 countries. Information from this registry has been used in more than 40 CDH Study Group reports. These projects evaluated diagnostic and prognostic variables such as preductal oxygen saturation, defect size/anomaly association and pulmonary hypertension.
Research trials under way include:
Children's Memorial Hermann Hospital is an internationally recognized leader in the care and research of CDH. Home to one of the most comprehensive CDH programs in the United States, Children’s Memorial Hermann Hospital combines affiliated specialists in fetal intervention and postnatal treatment, a CDH high-risk follow-up clinic and basic and translational research, all located at the same institution with an integrated team. The affiliated team of surgeons and physicians has a long, dedicated history of caring for newborns with CDH and has developed several advances in the postnatal treatment of this condition.
By utilizing expertise from pediatric surgery, neonatology, pediatric anesthesiology, and maternal-fetal medicine, the multidisciplinary team provides optimal and seamless care from prenatal diagnosis through delivery, postnatal care and long-term follow-up. In addition to the full range of specialists, Children’s Memorial Hermann Hospital established the first organized program for pediatric extracorporeal membrane oxygenation (ECMO) in Houston. Our neonatal critical care services include 118 bed Level II and Level IV Neonatal Intensive Care Unit, the highest NICU level, caring for the most acute patients. Physician specialists and nurses use high-tech therapies and advanced equipment without losing sight of the value of human touch to the infants in their care. This treatment approach has translated to higher-than-expected risk-stratified survival, as well as one of the highest rates of surgical repair in the world.
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6410 Fannin, Suite 210
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