Congenital diaphragmatic hernia (CDH) occurs when the diaphragm, the muscle that separates the chest from the abdomen, fails to close during prenatal development. The CDH opening can occur on the left or the right side of the diaphragm. The majority of babies with CDH have the opening on the left side.

What is the difference between right and left-sided CDH?

Where the CDH opening is can impact which abdominal organs migrate into the chest. The main difference between left and right CDH is typically the position of the liver.

• A left-sided CDH (present in ~83% of babies) allows for the possibility of the stomach, intestines, and sometimes the liver to move (herniate) up into the baby’s chest.
• A right-sided CDH (present in ~17% of babies) almost always allows the liver to move into the chest.

Position of the liver and impact on lung development

The normal position of the liver is in the abdomen on the right side. This is why when there is an opening on the right side of the baby’s diaphragm, the liver is more likely to move up into the chest.

When the liver is up in the chest, it takes up precious space where the baby’s lungs should be growing. Because it is a solid organ, it has a more significant impact on lung development than some other abdominal organs, causing the lungs to grow smaller (pulmonary hypoplasia).

Babies with left-sided CDH may also have some portion of the liver in their chest, but this happens less frequently when the opening is on the left, and it is more common to see the liver stay down below the diaphragm.

When calculating the amount of lung volume in babies with CDH, the measurements usually suggest a more favorable outcome for babies with the liver below the diaphragm. This is because when the liver stays down below the diaphragm, the lungs have more room to grow.

Outcomes of left vs. right CDH

The Richard D. Wood Jr. Center for Fetal Diagnosis and Treatment at Children’s Hospital of Philadelphia (CHOP) has studied the outcomes of babies born with right CDH to determine how their outcomes compared to babies born with left CDH.

For babies born at CHOP, there was no difference in survival, total length of hospitalization, or need for ECMO support between the two groups.

Some differences observed in our studies include:

• The timing of surgery to repair the CDH was later in babies with right-sided defects because it can take longer for babies with right CDH to stabilize to have surgery.
• Babies with right CDH are more likely to need treatment with nitric oxide, an inhaled gas used to keep the lungs relaxed so they can work more easily, because of the higher possibility of having pulmonary hypertension (high pressure in the lungs because of pulmonary hypoplasia).
• Right CDH babies are also more likely to need medications to keep their lungs relaxed after discharge.
• In right CDH, there is a greater likelihood of needing supplemental oxygen at the time of discharge, and more of a chance of needing a tracheostomy for long-term breathing support.

Because babies with right-sided CDH have a higher chance of potential challenges after they are born, it is especially important to have an accurate prenatal diagnosis. All babies prenatally diagnosed with CDH benefit from delivery at a high volume fetal center with experience caring for these fragile babies.

Finding the best treatment team

If you choose the Wood Center for Fetal Diagnosis and Treatment for your baby’s care, our team of expert maternal-fetal medicine specialists will monitor the remainder of your pregnancy and you can deliver here at our hospital in our Garbose Family Special Delivery Unit.

Your baby will be treated by a multidisciplinary team of pediatric surgeons, neonatologists, advanced practice nurses, surgical bedside nurses, and respiratory therapists from the moment of birth through discharge. As they grow, they’ll have access to our specialized Pulmonary Hypoplasia Program for support with any long term health challenges associated with smaller lungs.

Learn more about how CHOP is uniquely prepared to support you and your baby every step of the way, from before birth through delivery, surgery to repair the diaphragm, and long-term follow-up care. Why choose us for CDH care >>