Surgical conditions of the diaphragm: posterior diaphragmatic hernias in infants

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Priscilla P L Chiu1, Jacob C Langer

  • 1Division of Pediatric General and Thoracic Surgery, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, Canada.

Thoracic Surgery Clinics
|February 2, 2010
PubMed

Insights

Care for neonates with congenital diaphragmatic hernia (CDH) has advanced, improving survival rates. However, long-term health issues are now more recognized, with ongoing debates in treatment strategies.

Area of Science:

  • Neonatal care
  • Pediatric surgery
  • Congenital anomalies

Background:

  • Congenital diaphragmatic hernia (CDH) management has shifted from aggressive ventilation and emergency surgery.
  • Current approaches emphasize permissive hypercapnia, stabilization, elective repair, and multidisciplinary follow-up.

Purpose of the Study:

  • To outline the evolution of CDH care.
  • To highlight survival improvements and associated morbidities.
  • To identify areas of ongoing controversy in CDH management.

Main Methods:

  • Review of evolving clinical practices in CDH care.
  • Analysis of survival rates and associated morbidities.
  • Discussion of controversial management topics.

Main Results:

  • Overall survival for neonates with CDH now approaches 80%.
  • Improved survival is linked to increased recognition of respiratory, cardiac, gastrointestinal, and neurodevelopmental morbidities.

Conclusions:

  • Neonatal care for CDH has significantly improved survival.
  • Long-term morbidities require continued attention and research.
  • Key areas of controversy include fetal tracheal occlusion, ECMO, and minimally invasive surgical techniques.

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