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Current Concepts in the Management of Congenital Diaphragmatic Hernia in Infants

Vasanth H S Kumar1

  • 1Department of Pediatrics, University at Buffalo, State University of New York, Buffalo, NY USA.

The Indian Journal of Surgery
|December 25, 2015
PubMed

Insights

Congenital diaphragmatic hernia (CDH) management now focuses on pulmonary hypertension and stabilization, leading to improved survival rates. Long-term follow-up is crucial for infants with CDH to ensure optimal outcomes post-discharge.

Area of Science:

  • Pediatric Surgery
  • Neonatology
  • Medical Genetics

Background:

  • Congenital diaphragmatic hernia (CDH) management has evolved from immediate repair to a focus on pulmonary hypertension, physiological stabilization, and delayed surgical intervention.
  • Lung hypoplasia, pulmonary vascular remodeling, and ventricular dysfunction are key contributors to CDH-related morbidity and mortality.
  • Genetic syndromes associated with CDH can increase the incidence of anomalies and impact survival rates.

Purpose of the Study:

  • To review the current therapeutic approaches and management strategies for congenital diaphragmatic hernia (CDH).
  • To highlight advances in prenatal and postnatal care that improve prognosis and survival in CDH patients.
  • To emphasize the importance of multidisciplinary teams and long-term follow-up for optimal CDH outcomes.

Main Methods:

  • Review of current literature and clinical practices in congenital diaphragmatic hernia (CDH) management.
  • Analysis of advances in diagnostic tools such as ultrasound and fetal MRI for prognosis prediction.
  • Evaluation of therapeutic strategies including pulmonary hypertension management, gentle ventilation, and extracorporeal membrane oxygenation (ECMO).

Main Results:

  • Survival rates for CDH have improved over the past decade due to enhanced resuscitation, gentle ventilation, and medical management of pulmonary hypertension.
  • Prenatal imaging (ultrasound, fetal MRI) aids in predicting prognosis and planning postnatal care.
  • Multidisciplinary team management and extracorporeal membrane oxygenation (ECMO) have contributed to better outcomes.

Conclusions:

  • The contemporary management of CDH prioritizes physiological stabilization and delayed repair, significantly improving survival.
  • Advances in prenatal diagnostics and postnatal care, including ECMO, are critical for managing this complex condition.
  • Long-term follow-up is essential to address the chronic morbidities associated with CDH and ensure comprehensive patient care.

Keywords:
CDHECMOLung hypoplasiaNeonatePulmonary hypertension

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