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A Special Congenital Diaphragmatic Hernia Delivery 
 
Lucie on the day she went home from the NICU.

Lucie battled to make it into this world. At 19 weeks gestation, her parents, Laura and Ryan found out that a hole in Lucie’s diaphragm was causing her heart to be pushed to the side, and stopping her lungs from properly growing.

 

 

 

 

 

 

 

The condition, known as Congenital Diaphragmatic Hernia (CDH) can range from very severe, causing immediate distress at birth, to mild, causing no neonatal effect at all. In babies with CDH, the opening in the diaphragm leads to contents of the abdomen—such as the stomach, small intestine, spleen, liver, or kidney—developing in the chest cavity instead of the abdomen. As shown in the illustration to the left, the displaced organs prevent the lungs from developing properly.

When Laura was first seen at the St. Louis Fetal Care Institute, Lucie’s lung to head ratio (LHR) was 1.6. “Following the first MRI we found that she had a 40% predicted lung volume, so we knew she had a chance,” says Dr. Emanual (Mike) Vlastos, MFM, who is the director of the St. Louis Fetal Care Institute.

Throughout the pregnancy Laura and Lucie were monitored. “We closely monitor babies diagnosed with CDH before they are born because of the risk of hydrops, and heart failure,” says Vlastos.

Following her 35-week ultrasound, the team confirmed that Lucie was suffering from persistent polyhydraminos (excess amniotic fluid in the amniotic sac) severe hydrops, (pleural effusions and fetal edema).

Because of the challenges facing Lucie at the time of her delivery, the team determined that a Cesarean section delivery at SSM Cardinal Glennon Children’s Medical Center would provide the best opportunity for a positive outcome.

Cesarean section and EXIT deliveries at Cardinal Glennon provide babies with immediate access to a team of pediatric specialists and neonatologists at the time of birth, while the mother is under the experienced care of the St. Louis Fetal Care Institute maternal-fetal medicine team.

On July 1, the team gathered in a Cardinal Glennon operating room for Lucie’s delivery. “The pediatric surgery team was on standby ready to place her on ECMO or perform immediate life-saving surgical intervention if needed,” says Vlastos.   

When she was delivered Lucie was intubated, but did not require ECMO. “The left-sided Bochdalek hernia had caused the small intestine, colon, spleen and pancreas to spread to her chest,” says Vlastos.

After ten days in the NICU (Neonatal Intensive Care Unit), Lucie underwent surgery to repair the CDH. The surgery went well, and once she was breathing on her own and feeding she went home on July 29, 2013. Despite being small, Lucie is doing well and thriving at home.


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