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Antenatal management of congenital diaphragmatic hernia today and tomorrow

Lennart van der Veeken1,2, Francesca M Russo1,2, Johannes van der Merwe1,2

  • 1Academic Department of Development and Regeneration, Cluster Woman and Child, Biomedical Sciences, KU Leuven, Leuven, Belgium.

Minerva Pediatrica
|February 27, 2018
PubMed

Insights

Congenital diaphragmatic hernia (CDH) is a birth defect impairing fetal lung growth. Prenatal interventions like fetoscopic endoluminal tracheal occlusion show promise for improving outcomes in severe CDH cases.

Area of Science:

  • Perinatal Medicine
  • Fetal Surgery
  • Neonatology

Background:

  • Congenital diaphragmatic hernia (CDH) is a rare birth defect with significant fetal lung development impairment.
  • This condition leads to high mortality (30%) and morbidity due to underdeveloped lungs.
  • Prenatal diagnosis and intervention are crucial for improving infant outcomes.

Purpose of the Study:

  • To review current and emerging prenatal therapies for congenital diaphragmatic hernia.
  • To highlight the potential of fetoscopic endoluminal tracheal occlusion (FETO) in managing severe CDH.
  • To explore novel therapeutic strategies targeting pulmonary hypertension and lung growth.

Main Methods:

  • Review of existing literature on CDH management.
  • Analysis of outcomes from fetoscopic endoluminal tracheal occlusion (FETO) clinical trials.
  • Discussion of preclinical and early-phase clinical investigations of new therapies.

Main Results:

  • Prenatal medical imaging accurately predicts outcomes in isolated CDH cases.
  • Fetoscopic endoluminal tracheal occlusion (FETO) is effective in triggering lung growth and is under global evaluation.
  • Right-sided CDH cases with poor prognosis are clinically offered FETO.

Conclusions:

  • Fetoscopic endoluminal tracheal occlusion (FETO) represents a significant advancement in prenatal CDH management.
  • Ongoing research focuses on less invasive therapies, including prenatal sildenafil administration, to address persistent pulmonary hypertension.
  • A multi-modal approach combining fetal surgery and pharmacotherapy may offer improved survival and reduced morbidity for CDH patients.

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