Congenital Diaphragmatic Hernia (CDH) in Children

Neonatal & Paediatric Surgery | Professor Mohamed Elbarbary, FRCSEd — Cairo University

A diagnosis of congenital diaphragmatic hernia (CDH) is one of the most serious conditions a family can face during pregnancy or in the newborn period. Professor Mohamed Elbarbary — Cairo University Professor of Paediatric Surgery, Fellow of the Royal College of Surgeons of Edinburgh (FRCSEd 2026), and specialist with over 36 years of experience — has extensive expertise in the surgical management of CDH and other diaphragmatic defects. This page explains the condition, the treatment approach, and what families can expect.

What Is Congenital Diaphragmatic Hernia?

The diaphragm is the dome-shaped muscle that separates the chest cavity from the abdomen. In CDH, there is a defect (hole) in the diaphragm that allows abdominal organs — most commonly the bowel, stomach, and sometimes the liver or spleen — to herniate (push through) into the chest cavity during fetal development. This interferes with normal lung development and can cause significant respiratory problems at birth.

CDH occurs in approximately 1 in 2,000–4,000 births. The most common type is a left-sided posterolateral defect (Bochdalek hernia), accounting for about 80% of cases. Right-sided CDH and bilateral CDH are less common but often more severe. Morgagni hernias — anterior diaphragmatic defects — are a separate, usually less severe condition also treated by paediatric surgeons.

Diagnosis

CDH is increasingly diagnosed prenatally by routine fetal ultrasound at the 18–20 week anomaly scan, when abdominal organs may be visible in the chest. After birth, CDH typically presents with:

• Respiratory distress immediately or shortly after birth — often severe

• Low oxygen saturation despite ventilation

• A barrel-shaped chest and a scaphoid (flat) abdomen

• Absent or reduced breath sounds on the affected side

• Bowel sounds occasionally heard in the chest

Chest X-ray confirms the diagnosis in almost all cases.

Treatment

Stabilisation first

CDH is not primarily a surgical emergency in the immediate newborn period. The most critical phase is the initial medical stabilisation of the baby in the neonatal intensive care unit (NICU). The key priority is managing pulmonary hypertension (high blood pressure in the lungs — caused by the compressed, underdeveloped lungs) and establishing stable oxygenation, often with mechanical ventilation. In selected severe cases, ECMO (extracorporeal membrane oxygenation) may be used.

Surgery is typically planned once the baby has been medically stabilised — usually within the first few days to 1–2 weeks of life, depending on the baby’s condition.

Surgical repair

The goal of surgery is to return the herniated abdominal organs to their correct position in the abdomen and to close the diaphragmatic defect. Prof. Elbarbary offers:

• Open repair via a subcostal abdominal incision — the standard approach for large defects, or when stability does not allow laparoscopy

• Thoracoscopic (minimally invasive) repair — for selected stable patients, using small keyhole incisions in the chest wall

The diaphragmatic defect is repaired with sutures if it is small, or with a synthetic patch (GORE-TEX or similar) if the defect is too large to close primarily. The use of a patch is associated with a higher risk of hernia recurrence over time, which is closely monitored.

After Surgery

Recovery from CDH repair is closely monitored in the PICU or NICU. The baby continues on ventilatory support as needed and is weaned carefully as the lungs begin to expand. Pulmonary hypertension management continues post-operatively. Length of hospital stay varies widely by severity — from 2–3 weeks in mild cases to several months in severe cases.

Long-term follow-up is an essential part of CDH care. Potential long-term issues include:

• Recurrent hernia (particularly with patch repairs)

• Chronic lung disease and reactive airways in more severe cases

• Gastro-oesophageal reflux (common after CDH repair)

• Neurodevelopmental follow-up for babies who required ECMO or prolonged ventilation

Morgagni Hernia

Morgagni hernias are anterior diaphragmatic defects, often diagnosed incidentally in older children (or even adults). They are typically much less severe than Bochdalek CDH and are often repaired laparoscopically as an elective procedure once diagnosed. Outcomes are excellent.

Frequently Asked Questions

Is CDH always diagnosed before birth?

Not always. While prenatal ultrasound picks up the majority of CDH cases in settings with good antenatal care, some cases — particularly right-sided or Morgagni hernias — may first be identified at birth or even later in childhood. Late presentations are generally less severe than those diagnosed prenatally.

What is the survival rate for CDH?

Survival rates depend heavily on the severity of the defect, the degree of pulmonary hypoplasia (underdevelopment of the lungs), and the presence of other anomalies. In isolated CDH (without other major defects) managed at experienced centres, survival rates of 70–90% are reported. The most severe cases — particularly those with liver herniation into the chest, very low lung-to-head ratio on prenatal ultrasound, and requirement for ECMO — carry a higher risk. Every family deserves an honest, individualised discussion of prognosis based on their specific case.

Will my child need long-term follow-up?

Yes. CDH survivors require regular multidisciplinary follow-up including respiratory, surgical, nutritional, and developmental assessment. Recurrent hernia, chronic lung disease, feeding difficulties, and growth issues are monitored and managed as needed. Most children with mild to moderate CDH lead normal, active lives.

drmohamedelbarbary.com | Cairo University — Kasr Al-Ainy | FRCSEd 2026