Congenital Diaphragmatic Hernia (CDH) Program

Treatments and Services

We perform fetoscopic endoluminal tracheal occlusion (FETO) to help a baby’s lungs develop more fully before they are born. This minimally invasive fetal intervention is performed while your baby is still in the uterus.

Not every baby with CDH needs FETO. Benefits of the procedure include:

• Lower rates of extracorporeal membrane oxygenation (ECMO) use after birth
• Reduced need for mechanical ventilation
• Shorter length of stay in a newborn intensive care unit (NICU)

If you need high-risk obstetric care, you get expert guidance and treatment from our OB Clinic. We provide you with prenatal counseling, testing, and birth planning all in one location.

You may deliver your baby in the Special Delivery Unit of Cincinnati Children’s Fetal Care Center if your baby needs:

• Advanced medical care during or after birth
• Surgery right after birth

We are one of the only birthing centers in the world located inside a pediatric hospital.

This means your baby gets specialty care and evaluation from our on-site neonatologists and specialists. If you deliver here, there’s no need to transfer your baby away from you to another hospital.

We offer special delivery procedures that ensure your baby can breathe after delivery. Ex utero intrapartum treatment (EXIT) establishes an airway while your baby continues to receive oxygen from the placenta. We perform this procedure during a cesarean delivery.

EXIT-to-Airway Procedure

Here’s what occurs:

• The head and chest are delivered through the uterus.
• Endoscopes are used to clear the airway.
• Your baby is intubated if needed.

Once the airway is established, delivery is completed.

EXIT-to-ECMO Procedure

In severe cases of CDH, we perform EXIT-to-ECMO. ECMO is a heart-lung bypass machine for infants. Using ECMO gives the lungs and their blood vessels time to develop.

The Fetal Care Center is one of only a few in the U.S. to offer EXIT-to-ECMO. During the procedure:

• The head and chest are delivered through the uterus.
• An airway is secured.
• Arterial and venous cannulas are inserted for ECMO.

EXIT-to-ECMO gives the care team time to evaluate your baby. They can decide if emergency surgery is needed to repair the CDH.

This procedure can improve survival up to 65% for babies with the most severe cases of CDH. Without EXIT-to-ECMO, the survival rate for babies with high-risk CDH is between 11% and 40%.

Your baby will spend time in the NICU after birth. We provide advanced care to help the lungs develop, reduce other complications, and improve your baby’s chance of survival.

We follow many detailed protocols to ensure your baby’s health and encourage them to thrive, such as:

• Dialysis treatment: If your baby’s kidneys are not working properly, we provide safe continuous renal replacement therapy (CCRT), a type of dialysis. We use the innovative Cardio-Renal Pediatric Dialysis Emergency Machine (CARPEDIEM), which is specifically designed for the smallest patients.
• Heart-lung bypass: Babies with severe CDH need breathing support and time for their lungs and the blood vessels in the lungs to develop. We use ECMO to deliver oxygen to your baby while their heart and lungs rest and grow.
• Protective ventilation strategies: We use specialized ventilation strategies to protect the lungs, allow them to grow more normally, and avoid injury or scarring.
  • Airway pressure release ventilation (APRV): Allows spontaneous breathing throughout the entire pressure build-up and release cycle.
  • Neurally adjusted ventilatory assist (NAVA): Uses electrical signals from the diaphragm to generate breaths that match the baby’s natural breathing rhythm.
• Sedation: We use sedation to relax your baby while they are on a ventilator. This helps them breathe more easily. The sedation makes them sleepy but does not put them to sleep.
• Specialized nutrition: We ensure your baby gets the calories and nutrients they need to develop and heal.
• Treating pulmonary hypertension: The blood vessels in the lungs may narrow or not fully open. We use therapies to increase oxygen levels in the blood, open the blood vessels, and achieve normal blood pressure.

Most babies with CDH need surgery to close the hole in the diaphragm and place abdominal organs in the correct location within the body.

We perform the surgical repair days or weeks after birth. Your baby’s care team decides the best time for the procedure. We want your baby’s condition to be stable before we correct the hernia.

We use a minimally invasive approach—such as thoracoscopy—to access the chest and abdomen.

During surgery, your baby’s neonatal surgeon:

• Relocates the abdominal organs
• Repairs the hole in the diaphragm
• Uses an abdominal muscle flap to close large hernias and prevent recurrence

After surgery:

• Your baby is placed on ECMO.
• The lungs can grow into the new space within the chest.
• The lungs can recover while ECMO is used.