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CDH Survey
Q.1
Was your child born with CDH?
Yes
No
Q.2
Was your CDH child diagnossed during pregnancy?
Yes
No
Q.3
Is your CDH child a...
Boy
Girl
Q.4
Had you heard of CDH before your childs diagnosis?
Yes
No
Q.5
Were you on birth control or anti-depresants when you got prego with your CDH child?
Birth control
Anti-depressants
Both
None
Q.6
Which side was your CDH childs defect?
Left
Right
No diaphram at all
Q.7
Did your CDH child require at patch during original repair?
Yes
No
Q.8
Was your CDH child on ECMO?
Yes
No
Q.9
During repair surgery was your childs lung stretched? Or did they refer to your child as having a high diaphram on unrepaired side?
Xrays show evidance of lung being strentched
Diagnossed with High Diaphram on one side
neither
Q.10
Was your CDH child born with any other defects or abnormalities other than CDH?
Yes
No
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