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Management of congenital diaphragmatic hernia

Adrian T Bösenberg1, Robin A Brown

  • 1Department of Anaesthesia, Faculty of Health Sciences, South Africa. Adrian.Bosenberg@uct.ac.za

Current Opinion in Anaesthesiology
|May 7, 2008
PubMed

Insights

Recent research on congenital diaphragmatic hernia (CDH) management focuses on embryology, antenatal diagnosis, and interventions. Advances in perinatal care and fetal therapies are improving outcomes, but optimal surgical and ventilatory strategies require further study.

Area of Science:

  • Neonatal care
  • Pediatric surgery
  • Fetal medicine

Background:

  • Congenital diaphragmatic hernia (CDH) management is evolving with new insights into embryological development.
  • Earlier antenatal diagnosis and improved perinatal intensive care are transforming patient outcomes.
  • Research is exploring the genetic basis and molecular causes of pulmonary hypoplasia.

Purpose of the Study:

  • To evaluate recent research on congenital diaphragmatic hernia (CDH) management.
  • To assess the impact of new theories on embryological development, antenatal diagnosis, and fetal/postnatal interventions.
  • To understand advances in perinatal intensive care for CDH patients.

Main Methods:

  • Review of over 200 publications from 2007 addressing various aspects of CDH.
  • Evaluation of fetal MRI metrics (lung volume, lung-head ratio, liver position) as outcome predictors.
  • Appraisal of fetal interventions, delivery modes, surgical techniques, and pulmonary hypertension treatments.

Main Results:

  • Fetal MRI shows promise in predicting outcomes and aiding prenatal counseling.
  • Fetal interventions like endoluminal tracheal occlusion are being evaluated.
  • The influence of associated anomalies and therapeutic interventions on survivor quality of life is under continuous assessment.

Conclusions:

  • Deferred surgery post-stabilization and pulmonary hypertension reversal are key management strategies.
  • Optimal pre- and post-surgery ventilatory settings remain unproven.
  • Advancements in neonatal intensive care set a high benchmark for evaluating interventions like fetal endoluminal tracheal occlusion and ECMO.
Abstract

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