Diaphragmatic Hernia:
In this condition there is a slight herniation ofabdominal organs (stomach intestine and liver) or extreme protrusion of abdominal contents into the thoracic cavity at birth. It usually occurs on the left side. The abdominal contents may press the lungs and heart from normal position. The lung on affected side (usually left lung) is compressed and hypoplastic.
Assessment:
Child may present with severe respiratory distress (tachypnea, dyspnoea, retraction and cyanosis). The effected side of the chest does not expand. The abdomen is generally small and scaphoid in contour, but the chest appears relatively large. On percussion over the affected part of thorax, dull sound may be heard and ausculation reveals increased or decreased breaths sounds or absent breath sounds. Apical heart beat my be heard on right side because of dextrocardia and the peristalsis of intestine may be heard in the chest. Diagnostic evaluation includes X-ray of chest which shows loops of intestine containing fluid and air and mediastinum is shifted to the opposite side.
Management:
Resuscitation of new born at birth is necessary and use of positive pressure breathing should be done carefully. This is followed by surgical correction of the defect. Patient is placed on affected side to allow the expansion of the lung which is not severly compressed and patient is placed in semifowlers position.