Overview

• Congenital Diaphragmatic Hernia (CDH)
  • Herniation of abdominal viscera into the chest cavity due to incomplete formation of the diaphragm.
    • Often have associated pulmonary hypoplasia.
  • Most Common = bochdalek hernia (loops of bowel herniate into left chest area).
  • Sx → respiratory distress in neonate that fails to resolve, bowel sounds heard in chest.
    • Presence of liver in thoracic cavity is a poor prognostic factor.
  • Ix → diagnosis confirmed via CXR.
  • Mx → respiratory support (intubation + ventilation), stabilise the lungs (NG Tube + suction to relieve pressure on lungs).
• Gastroschisis
  • Congenital defect in the anterior abdominal wall just lateral to the umbilical cord (NO PERITONEAL COVERING).
  • Associated with socioeconomic deprivation.
  • Management → vaginal delivery may be attempted. Newborns should undergo surgical correction ASAP (within 4 hours). Initially should be incubated and fluid-resuscitated.
• Exomphalos (Omphalocele)

  • Abdominal contents protrude thorugh the anterior abdominal wall but are covered in an amniotic sac formed by amniotic membrane and peritoneum.

    <aside> 💡 Omphalocele → covered by amniotic sac + associated with other anomalies (trisomies 13, 18 and 21, Turner syndrome, and cardiac defects). [Whereas Gastroschisis is not].

    </aside>

  • AFP may be raised with fetal abdominal wall defects.

  • Management → staged repair (start closure immediately, finish at 6-12 months) is preferred, to reduce risk of respiratory insufficiency or inability to close the abdomen.

    • Plan c-section at 37 weeks to reduce risk of sac rupture.
• Talipes Equinovarus (’Club Foot’)
  • One or both feet are inverted and supinated. Causes the position of the foot to be fixed.
  • Associations → neuromuscular disorders (spina bifida), edward syndrome, oligohydramnios, cerebral palsy.
  • Mx → ponseti method. Involves gentle manipulation of the feet, followed by casting and bracing.
• Tracheoesophageal Fisstula & Oesoophageal Atresia
  • Associations → polyhydramnios.
  • Investigations → quick confirmation: NG tube to aspirate stomach contents. Gold-standard: gastrograffin swallow.
• Cleft Lip/Palate
  • Combined cleft lip and palate (45%) > Isolated cleft palate (40%) > Isolated cleft lip (15%).
  • 75% detected at 20w anomaly scan. Increased risk of secretory otitis media.
  • Risk Factors (psych drugs) → maternal antiepileptic (phenytoin) and benzodiazepine use.
  • Management → surgery: 3m for cleft lip, 6-12m for cleft palate.

Making Diagnosis

Clinical Features

Investigations

Management Plan

Complications →

Prognosis →