An evidence-based review of the current treatment of congenital diaphragmatic hernia
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Published on: February 5, 2021
Junaid Haroon1, Ronald S Chamberlain
1Saint Barnabas Medical Center, Livingston, NJ 07039, USA.
Insights
Congenital diaphragmatic hernia (CDH) is a severe condition in newborns. Treatment is shifting towards initial stabilization and delayed surgery, with fetal intervention showing promise for improved lung development and outcomes.
Area of Science:
- Pediatric Surgery
- Neonatology
- Fetal Medicine
Background:
- Congenital diaphragmatic hernia (CDH) affects 1 in 2000-3000 newborns, with a 67% survival rate.
- Prenatal diagnosis is common, but treatment has historically focused on immediate postnatal surgical repair.
Purpose of the Study:
- To review the evolving treatment strategies for CDH.
- To highlight the benefits of delayed surgical repair and fetal interventions.
- To address long-term complications and the need for standardized care.
Main Methods:
- Review of recent literature on CDH management.
- Discussion of advancements in fetal endoscopic tracheal occlusion (FETO).
- Analysis of outcomes associated with current therapeutic approaches.
Main Results:
- Evidence supports initial stabilization and gentle ventilation before surgery, favoring delayed repair.
- Fetal intervention, such as FETO, aims to improve lung development and reduce postnatal morbidity.
- Despite advancements, patients face significant long-term complications.
Conclusions:
- The management of CDH is transitioning towards less invasive, more lung-protective strategies.
- Standardization of care through international collaboration is crucial for optimizing outcomes in CDH patients.
Abstract:
Congenital diaphragmatic hernia is a rare but severe condition affecting 1 in 2000 to 3000 newborns with a survival rate of 67%. Although regular antenatal screening allows prenatal diagnosis in many cases, traditionally treatment has been based on postnatal surgical repair. Recent literature has pointed out the survival benefits of initial stabilization and the use of gentle ventilation strategies prior to definitive treatment, shifting the trend from immediate to delayed surgical repair. Advances in fetal intervention have allowed the introduction of fetal endoscopic tracheal occlusion as a method to hasten lung development before birth in order to minimize postnatal morbidity. Despite appropriate treatment, the long-term outcomes of these patients are plagued with numerous complications, associated with the primary pathology and also aggressive therapeutic measures. International centers of excellence have recently come together in an effort to standardize the care of such patients in hopes of maximizing their outcomes.
