Congenital diaphragmatic hernia (CDH) is a disease in which some abdominal organs enter the thoracic cavity through the defect due to incomplete closure of the diaphragm during the embryonic period to unilateral or bilateral diaphragmatic defects, resulting in abnormal anatomic relationships, and is divided into postero-lateral hernia, retrosternal hernia, and esophageal hiatal hernia. Postero-lateral hernia is the most common diaphragmatic hernia in infants and young children, located in the lateral front of the area where the lumbar vertebrae meet the diaphragm, mostly on the left side, without a hernia sac, and can develop after birth because a large number of intra-abdominal organs have herniated into the thoracic cavity during fetal development. The mortality rate can be more than 90% if not treated urgently, so early diagnosis and surgery are necessary. Surgical treatment is effective. Posterior sternal hernia is located behind the connection between the sternum and the rib cage, mostly on the right side, more females than males, with females accounting for about 70% of the cases, mostly in adulthood, with good surgical results. 2. Posterior lateral diaphragmatic hernia is the most common diaphragmatic hernia in infants and children. Because of the large hernia hole, a large number of intra-abdominal organs are herniated into the thoracic cavity to compress the lungs, and the heart and mediastinum are pushed to the opposite side. They often seek medical attention for shortness of breath, dyspnea, rapid heart rate, cyanosis, and decreased blood pressure, and are easily misdiagnosed as respiratory or cardiovascular diseases and delayed in treatment. According to the different organs herniated into the chest, congenital diaphragmatic hernia may show turbid or bulging sounds on chest percussion, decreased or absent breath sounds on the affected side, sometimes intestinal sounds can be heard in the chest, the heart and trachea are displaced to the opposite side, the abdomen is flat and soft, and the frog abdomen disappears in infants. Chest X-ray of congenital diaphragmatic hernia may show inflated gastric alveoli and intestinal curvatures on the affected side of the chest, compression of lung tissue and mediastinal displacement of the heart. Upper gastrointestinal angiography or barium enema can clarify the diagnosis. Once the diagnosis of congenital diaphragmatic hernia is clear, surgery should be performed as soon as possible to avoid the formation of adhesions or complications of intestinal obstruction or strangulation. Preoperative gastrointestinal decompression tubes should be placed in infants and young children to prevent severe ventilatory dysfunction due to further pulmonary compression during rabbit anesthesia and surgery. In infants and young children, transthoracic surgery is appropriate because the herniated organ is often already adherent to the intrathoracic organs. A posterior-lateral incision is made on the affected side of the chest, and the abdominal organs are retracted after opening the chest to repair the diaphragmatic defect. If the diaphragmatic defect is large, it must be repaired with synthetic woven sutures if necessary. Congenital diaphragmatic hernia should be suspected if your child has the following symptoms and prompt surgical consultation is recommended: 1. Difficulty in breathing, shortness of breath, cyanosis, and recurrent cough. Severe cases may begin at birth or appear within hours after birth. Its severity depends on the size of the diaphragmatic defect, the number of abdominal organs entering the thoracic cavity and the degree of pulmonary dysplasia. Dyspnea and cyanosis can be paroxysmal and variable, i.e., worsening with crying or eating, or sudden and progressive. If not treated in time or improperly treated, death can occur immediately. 2. Repeated vomiting. Vomiting occurs when there is a thoracoabdominal hiatal hernia with poor bowel rotation or intestinal obstruction caused by herniation into the abdominal organs. 3. Frequent respiratory tract infections, repeated cough, sputum, fever, weakness, emaciation, anemia, and growth retardation. At the first visit, after detailed history and symptoms, the attending physician will do the following examinations for your child: 1.General examination: to assess the child’s nutrition, development, whether it is combined with anemia, other congenital anomalies, etc. 2.Specialty examination: including visual and auscultation of the chest and heart and lungs and other detailed physical examination. If the physician initially considers that your child is diagnosed with congenital diaphragmatic hernia, the following tests will be ordered to further confirm the diagnosis: Chest X-ray frontal and lateral examinations, and CT scan of the chest and gastrointestinal imaging if necessary. Surgery: 1. Anesthesia: Intravenous complex anesthesia with tracheal intubation. 2.Surgery: posterior lateral incision on the affected side of the chest is chosen, and the abdominal organs are retracted after opening the chest to repair the diaphragmatic defect. If the diaphragmatic defect is large, a synthetic fiber suture must be used to repair it if necessary. 3. After surgery, the child is transferred to the intensive care unit (PICU) for monitoring. Generally, the child can be transferred back to the thoracic surgery ward after 1-2 days of stable condition. Post-operative management: 1. routine electrocardiographic monitoring, oxygen saturation monitoring, oxygen inhalation, sputum inhalation if necessary; 2. diet: post-operative fasting is required and gradually transition to normal diet after the child’s gastrointestinal function is restored; 3. intravenous rehydration: broad-spectrum antibiotics, hemostatic drugs, intravenous nutritional support, etc. are required after surgery, which usually lasts 5-7 days.