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[Antenatal care for fetuses with congenital diaphragmatic hernia]
Charles Mégier1, Alexandra Letourneau2, Lina Bejjani2
1Service de gynécologie-obstétrique, CPDPN Paris Saclay, hôpital Bicêtre, AP-HP, université Paris Saclay, Le Kremlin-Bicêtre, France; Centre de référence maladies rares : hernie de coupole diaphragmatique, Clamart, France.
Insights
Congenital diaphragmatic hernia (CDH) diagnosis and severity are assessed prenatally. Fetal tracheal occlusion (FETO) improves survival for severe CDH but increases prematurity risk, while improved neonatal care enhances long-term outcomes.
Area of Science:
- Perinatal medicine
- Pediatric surgery
- Fetal therapy
Background:
- Congenital diaphragmatic hernia (CDH) is a serious birth defect.
- Prenatal diagnosis and severity assessment are crucial for fetal prognosis.
- Management requires specialized centers and adherence to national protocols.
Purpose of the Study:
- To review the current understanding and management of congenital diaphragmatic hernia.
- To highlight advancements in prenatal diagnosis, fetal intervention, and neonatal care.
- To discuss the impact of these advancements on patient outcomes.
Main Methods:
- Review of prenatal imaging techniques (ultrasound, MRI) for CDH assessment.
- Evaluation of fetal endoscopic tracheal occlusion (FETO) for severe CDH.
- Analysis of neonatal resuscitation and standardized follow-up protocols.
Main Results:
- Prenatal imaging accurately assesses CDH severity (isolated vs. non-isolated, lung volume, liver position).
- FETO significantly increases survival to discharge in moderate/severe CDH but raises prematurity risk.
- Advances in neonatal care and specialized follow-up improve long-term prognosis.
Conclusions:
- Multidisciplinary management, including specialized centers and fetal interventions like FETO, is essential for CDH.
- Balancing the benefits of FETO with the risk of prematurity is critical.
- Ongoing improvements in neonatal care and long-term follow-up are enhancing outcomes for children with CDH.
Abstract:
Congenital diaphragmatic hernia (CDH) can be diagnosed prenatally and its severity assessed by fetal imaging. The prognosis of a fetus with CDH is based on whether or not the hernia is isolated, the measurement of lung volume on ultrasound and MRI, and the position of the liver. The birth of a child with CDH should take place in a center adapted to the care of such children, and in accordance with the recommendations defined by the French National Diagnosis and Care Protocol. It has recently been demonstrated that for moderate and severe forms of CDH, tracheal occlusion using a balloon placed in utero by fetoscopy (FETO) increases survival until discharge from the neonatal unit, but at the cost of an increased risk of prematurity. At the same time, advances in neonatal resuscitation and the standardization of follow-up of these children within the framework of the "Centre de référence maladies rares: hernie de coupole diaphragmatique" have improved the prognosis of these children and young adults.
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