Related Experiment Videos
Current and emerging treatment for congenital diaphragmatic hernia
1Pediatric Intensive Care Unit, Children's Hospital of Wisconsin, Milwaukee 53201, USA. jbraby@chw.org
Insights
Congenital diaphragmatic hernia management has evolved with prenatal detection and advanced postnatal therapies. Despite these improvements, survival rates for this condition remain around 63 percent.
Area of Science:
- Neonatal surgery
- Pediatric pulmonology
- Maternal-fetal medicine
Background:
- Congenital diaphragmatic hernia (CDH) management has shifted from early abdominal content repair to addressing pulmonary hypoplasia and hypertension.
- Historically, immediate abdominal content return was favored, but understanding now focuses on lung development and pulmonary vascular resistance.
Purpose of the Study:
- To review the evolution of congenital diaphragmatic hernia management strategies.
- To highlight advancements in prenatal and postnatal treatment modalities for CDH.
- To assess the current survival rates in light of therapeutic progress.
Main Methods:
- Review of historical management approaches for CDH.
- Description of advancements in diagnostic tools like ultrasonography.
- Compilation of various prenatal and postnatal treatment options, including novel therapies.
Main Results:
- Prenatal detection via ultrasonography is now standard.
- Prenatal interventions like tracheal ligation and postnatal therapies such as ECMO have been introduced.
- Despite advancements, the overall survival rate for CDH remains approximately 63 percent.
Conclusions:
- Modern CDH management incorporates sophisticated prenatal and postnatal interventions.
- Pulmonary hypoplasia and hypertension are key factors influencing CDH outcomes.
- Continued research is needed to improve survival rates for congenital diaphragmatic hernia.
Abstract:
Management of congenital diaphragmatic hernia has changed dramatically over the past couple of decades. Until the early 1980s, it was felt that the abdominal contents should be returned to the abdomen as soon as possible to allow the lungs to expand. It is now known that it is not the defect that causes respiratory distress, but the infant's hypoplastic lungs and accompanying pulmonary hypertension. Advances in treatment and technology have contributed to changes in management. Ultrasonography now allows for early prenatal detection. Prenatal treatment modalities include in utero tracheal ligation and maternal antenatal steroids. Postnatal modalities have expanded to include permissive hypercapnia, high-frequency ventilation, inhaled nitric oxide, pharmacologic support, exogenous surfactant, and extracorporeal membrane oxygenation. Liquid ventilation and lobar lung transplantation have also been tried. In spite of these advances, the overall survival rate remains about 63 percent.