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Diaphragmatic Defects in Infants: Acute Management and Repair

Robert J Vandewalle1, Lawrence E Greiten2

  • 1Department of Surgery, University of Arkansas for Medical Sciences/Arkansas Children's Hospital, 1 Children's Way, Slot 844, Little Rock, AR 72202, USA.

Thoracic Surgery Clinics
|May 5, 2024
PubMed

Insights

Congenital diaphragmatic hernia (CDH) requires specialized care. Early surgical repair during extracorporeal membrane oxygenation (ECMO) may improve survival rates for infants with this complex condition.

Area of Science:

  • Pediatric Surgery
  • Neonatology
  • Critical Care Medicine

Background:

  • Congenital diaphragmatic hernia (CDH) is a complex congenital anomaly with significant variability.
  • Neonatal management focuses on respiratory and cardiac support due to pulmonary hypoplasia and hypertension.

Purpose of the Study:

  • To review the current management strategies for congenital diaphragmatic hernia.
  • To highlight the role of multidisciplinary teams and extracorporeal membrane oxygenation (ECMO) in CDH care.
  • To discuss optimal timing and approaches for surgical repair.

Main Methods:

  • Literature review of congenital diaphragmatic hernia management.
  • Analysis of treatment outcomes based on timing of intervention and surgical technique.

Main Results:

  • Specialized centers with multidisciplinary teams are crucial for optimal CDH patient outcomes.
  • Extracorporeal membrane oxygenation (ECMO) is a viable option for medically refractory cases.
  • Early surgical repair during ECMO support appears to be associated with improved mortality.

Conclusions:

  • Optimal congenital diaphragmatic hernia management necessitates a coordinated, multidisciplinary approach.
  • Timing of surgical intervention, particularly early repair during ECMO, is a critical factor in improving survival.
  • Surgical approach selection should be individualized based on patient physiology and surgeon expertise.

Keywords:
Congenital diaphragmatic hernia (CDH)Extracorporeal membrane oxygenationPulmonary hypertensionSurgical management

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