Hernia Found in Preemies

Lynsey Keep, RN
examination

All new parents naturally worry about the health of their newborn infant, and a common problem faced is that of hernia found in preemies. Fortunately being such a common problem, if necessary it can be fixed in the early days or months of life.

Types of Hernia

A hernia is a protrusion of an organ or other internal structure through the wall of the muscle where it does not belong. A hernia will look like a simple lump which is clearly not meant to be there. It will neither be red nor sore in appearance. The two common types of hernia found in preemies are:

Umbilical Hernia

This is when the protrusion appears at the site of the umbilical cord. It is often most prominent when the baby coughs, screams or strains. Because of the presence of many organs in the abdominal cavity, a preemie may be at risk of umbilical hernia because of her less well formed bodily structure, dependant on the degree of prematurity. Umbilical hernias are more common in low birth weight babies.

Hernias are often retractable, meaning they can reduce simply when the pressure (i.e. of the screaming) is relieved. Due to the presence of the umbilical cord or stump which is left when the cord drops off, it is sometimes not always obvious that a hernia is present, and it is often only a chance sighting of an unusual lump that alerts parents to something which is not quite normal.

Inguinal Hernia

This type of hernia presents in either or both groins. It is rare that both groins herniate at the same time. While the infant grows in the womb, there is an opening between the abdominal cavity and the scrotum that, if born prematurely, may not entirely close, therefore creating a risk that a small loop of bowel may slip (herniate) through the hole, resulting in an inguinal hernia. Inguinal hernias are more common in:

  • Preemie infants.
  • Those with cystic fibrosis.
  • Boys with un-descended testicles.
  • In some cases when the urethra opens in an unusual area of the penis.

As with umbilical hernias, the protrusion often occurs when the infant strains. Inguinal hernias can be more obvious to detect as they occupy a smaller space, and when they are prominent there is no mistaking something is not supposed to be there.

Problems Associated With Hernias

It is rare that issues arise with hernias in preemies and other infants; however, the risk is still present, and parents ought to be fully informed of them. Albeit low, there is a risk that hernias can incarcerate, and this usually occurs when the herniated tissue fails to retract back through the hole in the muscle. A strangulated hernia is the most obvious surgical risk. This occurs when pressure is applied to the protruding tissue and blood supply is compromised. The infant is likely to experience severe pain, vomiting and general irritability. In the event that this happens, surgery is the only way to correct the problem. This is then performed as a matter of urgency.

Treatment Required

In preemies and other infants if a hernia is present, it will be detected within days or weeks of birth. It is common practice that surgery will be performed to correct the problem, simply because of the small risk of incarceration. The surgery is simple and requires the infant to be in hospital for one day or at the most overnight for observation.

Due to the simplicity and lack of disruption caused, the surgery is often performed when the baby is deemed well and strong enough to cope with it. This is often within the first few months of life. A hernia found in preemies is treated no differently, and therefore infants born early are also expected to have surgery in an early stage.

Alternatives to Surgery

In some cases hernias can be fixed by manual retraction methods. Performed only by an experienced surgeon or pediatrician, it is possible to coax some hernias back into their correct place by manual manipulation. This is often only a temporary measure, and over time hernias do tend to return. Retraction of a hernia can be a short term solution, particularly if an infant (particularly a preemie) is deemed too young to undergo surgery.

Although there has been much controversy in the surgical field regarding elective surgery on infants and preemies, it is nearly always concluded that preventative surgery is far safer than performing emergency surgery. Infection and anesthetic risks are far lower when surgery is planned and well organised. It too gives parents sufficient time to prepare themselves emotionally and practically for what their precious infant is about to go through.

Hernia Found in Preemies