Congenital Diaphragmatic hernia - a review

Area of Science:

• Pediatric Surgery
• Neonatology
• Developmental Biology

Background:

• Congenital Diaphragmatic Hernia (CDH) involves a diaphragm defect, allowing abdominal organs into the chest, hindering lung growth.
• This condition causes lung hypoplasia, persistent pulmonary hypertension of the newborn (PPHN), and cardiac issues.

Purpose of the Study:

• To outline the pathophysiology, diagnosis, and current management strategies for Congenital Diaphragmatic Hernia.
• To discuss factors influencing survival and recent advancements in CDH care.

Main Methods:

• Prenatal diagnosis using lung-to-head ratio (LHR) and liver position via ultrasound.
• Immediate postnatal management including bowel decompression and avoiding mask ventilation.
• Treatment focuses on gentle ventilation, hemodynamic support, PPHN management, and surgical repair.

Main Results:

• Inhaled nitric oxide is commonly used for PPHN, though not FDA-approved for CDH.
• Extracorporeal membrane oxygenation (ECMO) is reserved for severe cases failing conventional treatment.
• Survival rates range from 70-90% for non-ECMO infants and up to 50% for ECMO-treated infants.

Conclusions:

• Survival in CDH is influenced by prematurity, anomalies, PPHN severity, repair type, and ECMO use.
• Advances in management have significantly improved overall survival for infants with CDH.
• Multifaceted care, from prenatal assessment to surgical intervention and intensive support, is crucial for optimizing outcomes.