What are the clinical features of CDH?
The presenting symptom of CDH is respiratory
distress, with tachypnea and cyanosis, in the neonatal period. On visual
inspection, the abdomen may appear scaphoid and the thorax barrel-shaped. On
physical examination there is an absence of breath sounds on the affected side
(most commonly the left side) and the cardiac impulse will be shifted to the
opposite side of the defect (most commonly the right side). Bowel sounds on the
affected side is an uncommon finding.
The time of onset of the respiratory symptoms
correlates well with the degree of lung hypoplasia and therefore with
prognosis. The earlier the symptoms present, the greater the degree of lung
hypoplasia is present. Those neonates pre-senting in the first hour of life
have the highest mortality.