Congential diaphragmatic hernia results

from herniation of the intestinal tract

through a defect in the diaphragm. It
results from the failure of closure of the
pleuroperitoneal canal during the eighth
week of fetal life.
The defect most frequently occurs at the
foramen of Bochdalek. The defect can
vary from several centimeters to complete
absence of the involved hemidiaphragm

 In 85% of the cases the defect is of

the left hemidiaphragm; less than 1%
is bilateral.
TP After delivery, infants present
with respiratory distress, cyanosis,
and scaphoid abdomen.

 Immediate tracheal intubation and placement of

a nasogastric tube are undertaken to prevent
gaseous distention of the herniated intestine.
Treatment with nitric oxide was initially a
mainstay of therapy, but recent studies may
show that it provides no benefit. ECMO may be
necessary in the more severe cases. The timing
of surgical repair is based on the infant's
respiratory status. Most centers delay repair of
the diaphragm for a number of days to allow
time for the pulmonary vasoreactivity to diminish

 Esophageal atresia is characterized

by incomplete formation of the
esophagus and is frequently
associated with a fistula between the
trachea and the esophagus. Many
anatomic variations of esophageal
atresia with or without
tracheoesophageal fistula have been
described

 the neonate with esophageal atresia has

copious, white, frothy bubbles of mucus in
the mouth and sometimes the nose. These
secretions may clear with aggressive
suctioning but eventually return. The infant
may experience episodes of coughing,
choking, and cyanosis, especially during
feeding. Abdominal distention may be
prominent if a fistula between the distal
esophagus and the trachea is present. The
abdomen will be scaphoid if no fistula exists.

 Diagnosis can be made by failure to

pass a feeding tube into the
stomach; however, it needs to be
confirmed by radiographic study of
the chest and abdomen with the
feeding tube in place

 A suction catheter (Replogle

catheter, No. 8 to 10 French gauge)
is placed in the upper esophageal
pouch to suction secretions. An
infant with respiratory distress
requires endotracheal intubation and
mechanical ventilation

 CHARGE is an acronym for a cluster

of anomalies that includes C
oloboma, H eart defects, choanal A
tresia, R etardation of growth and
development, and G enital and E ar
anomalies. Other associated features
may include tracheoesophageal
anomalies, urinary tract
abnormalities, deafness, and
characteristic facial and hand

 VACTERL is an acronym for a cluster

of abnormalities consisting of V
ertebral anomalies, A nal atresia, C
ardiac anomaly, T racheo E
sophageal fistula or atresia, R enal
and L imb (typically radius)
abnormalities. The patient also may
have associated growth deficiency.
Occasionally, the acronym has an S
at the end for association with single