Babies born with congenital diaphragmatic hernia are at high risk of having severe breathing problems since their lungs have not developed properly. Managing these problems is the first and most important step in caring for babies with CDH after birth. Some of these babies are placed on a ventilator (breathing machine), but those with very severe breathing problems will need ECMO (extracorporeal membrane oxygenation), a type of heart-lung bypass machine. ECMO bypasses the narrow blood vessels in the baby’s lungs (due to the pulmonary hypoplasia), giving the lungs and blood vessels the chance to rest and develop.
When a baby has severe CDH, our team may recommend a special birth plan involving EXIT-to-ECMO (ex utero intrapartum treatment-to-extracorporeal membrane oxygenation). EXIT-to-ECMO is a different type of cesarean delivery in which the baby is more slowly removed from the womb and immediately placed on ECMO. This technique allows the baby to have a steady supply of oxygen throughout the birth process and lets the medical team look more closely at the baby to see how severe the baby’s condition is. It also gives time to determine whether emergency surgery is needed to repair the CDH. EXIT-to-ECMO is thought to improve survival for babies with the most severe cases of CDH.
Cincinnati Fetal Center is one of only a few institutions in the United States offering EXIT-to-ECMO for patients with severe CDH. EXIT-to-ECMO is thought to improve survival to 65 percent for this very high-risk group of patients. Without it, the survival rate is usually 11 percent to 40 percent.
Surgery for CDH
Some babies with congenital diaphragmatic hernia do not require surgery after birth to repair the defect. Many, however, do. The surgery takes place days or weeks after birth, once the baby’s condition has become more stable. During surgery, the surgeon places the abdominal organs in their proper position and repairs the opening in the diaphragm. Afterward, the baby is placed on ECMO, giving the lungs a chance to recover and expand.