By Heather Cresswell, Neonatal Nurse Practitioner
In June’s blog post, we talked about a type of hernia (umbilical hernias) that rarely needs medical intervention. Inguinal hernias (in the groin) are a different story and something that many preemie parents – especially parents of premature baby boys – will learn about firsthand.
What is an inguinal hernia?
An inguinal hernia happens when a small part of the intestines moves from the abdomen into the groin area.
During fetal development, babies have an opening between the belly and the groin called the inguinal canal. This opening allows the testicles in baby boys to move from the abdomen to the scrotum. The inguinal canal closes before or shortly after birth, but this can take longer in premature babies.
The most common reason babies get inguinal hernias is that intestines pass through the open inguinal canal into the groin. This will cause an abnormal bulge in the groin area or scrotum.
How common are inguinal hernias in babies?
About 3% of babies will develop an inguinal hernia. This number is much higher in premature babies, with as many as 30% developing inguinal hernias. The lower the gestational age at birth, the higher the risk.
Although baby girls can have inguinal hernias, they are much more common in boys (about 85% of infant inguinal hernias happen in boys).
How do you know if a baby has an inguinal hernia?
Inguinal hernias are not usually present at birth but develop in the first days, weeks or, less commonly, months of life. A healthcare provider will routinely palpate (feel) around the groin and scrotum during routine physical exams and may suspect or diagnose an inguinal hernia when they detect a bulge.
Sometimes, a healthcare provider may order an ultrasound of the groin if they suspect a hernia. Inguinal hernias can sometimes be seen on an X-ray (although X-rays are not usually done for this specific purpose).
Because inguinal hernias can develop over time, your baby’s healthcare provider will continue to check the groin area even after discharge from the NICU. If you notice a bulge or swelling in the groin, consult your baby’s healthcare provider.
How are inguinal hernias in babies treated?
Inguinal hernias almost always need an eventual surgical procedure as they do not close on their own. Surgery is not usually urgent, and for premature babies, it will usually be done sometime after NICU discharge. The surgical incision is small, and most babies can go home the same day (some babies may need a short hospital stay).
If your baby has an inguinal hernia, the NICU team or your healthcare provider will refer your baby to a surgeon. You can expect that you will first have a consultation (when the surgeon meets your baby, does a physical exam, explains the procedure, and answers your questions). The procedure will usually be scheduled for a later date after the consultation. A more urgent procedure may be needed if complications develop, but this is rare.
What to watch for if your baby has an inguinal hernia
All babies with inguinal hernias need to be watched for signs of complication. Rarely, a loop of intestine or other tissue can get trapped in the hernia and not get enough blood supply. This is called a strangulated or incarcerated hernia and is an emergency.
Take your baby to the nearest emergency room if your baby has any of these signs:
Vomiting;
The hernia is painful;
The hernia is red or discoloured in any way;
The hernia is swollen and hard.
If your baby is in the NICU, the team will help you keep an eye on the hernia and teach you what to watch for at home. If your baby is diagnosed with a hernia outside of the NICU, ask your healthcare provider to teach you how to monitor for complications.
Most hernias do not cause complications, and although no parents want their baby to need surgery, the repair is generally straightforward.
Key References
AboutKidsHealth (SickKids). 2024. Hernias. Accessed August 2024.
Ramachandran, V., Edwards, F., & Bichianu, D. (2020). Inguinal Hernia in Premature Infants. NeoReviews. Accessed August 2024.
Heather Cresswell is a Neonatal Nurse Practitioner and health writer. As a nursing student in 1995, Heather discovered the NICU during a clinical placement and never looked back. She has spent her entire nursing career (more than 25 years and counting) caring for NICU patients (premature babies are her favourite!). When not caring for her tiny patients, Heather is also a health writer and is happy to contribute to the Canadian Premature Babies Foundation.
Heather lives with her family in Burlington, Ontario, and is a proud mom to one son.
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