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Postnatal management of preterm infants with congenital diaphragmatic hernia

Emma E Williams1,2, Stephanie Lau2, Nimrah Abbasi3,4

  • 1Division of Neonatology, The Hospital for Sick Children, Toronto, ON, Canada.

Pediatric Surgery International
|January 17, 2025
PubMed

Insights

Management of preterm congenital diaphragmatic hernia (CDH) remains challenging. This study highlights high morbidity and mortality, emphasizing the need for standardized guidelines and further research in preterm CDH infants.

Area of Science:

  • Neonatal Surgery
  • Pediatric Surgery
  • Critical Care Medicine

Background:

  • Congenital diaphragmatic hernia (CDH) management in preterm infants is complex, especially with the rise of fetal endoluminal tracheal occlusion (FETO) therapy.
  • Current clinical guidance for managing preterm CDH is limited, necessitating a review of existing practices.
  • This study describes the experience of a single quaternary neonatal intensive care unit (NICU) in managing preterm CDH.

Purpose of the Study:

  • To describe the clinical experience and outcomes of preterm infants with CDH managed at a single quaternary NICU.
  • To identify challenges and inform potential improvements in the management of this vulnerable population.

Main Methods:

  • Retrospective, single-center observational case series.
  • Inclusion criteria: preterm infants (<37 weeks gestation) diagnosed with CDH (pre- or post-natally) between 2017 and 2024.
  • Data collected on gestational age, birth weight, prenatal diagnosis, FETO, surgical repair timing, ventilation duration, and outcomes.

Main Results:

  • Thirty-two preterm infants (median gestational age 33.9 weeks) were analyzed.
  • Prenatal diagnosis occurred in 68.8%, with 43.8% undergoing antenatal FETO.
  • Survival to discharge was 59.4%, with significant morbidity including intraventricular hemorrhage and need for home oxygen.

Conclusions:

  • Preterm CDH is associated with high rates of morbidity and mortality.
  • There is a critical need for robust clinical evidence, multicenter studies, and standardized guidelines to improve outcomes for preterm CDH patients.
  • Further research is essential to optimize management strategies for this challenging patient group.
Abstract

Keywords:
Congenital diaphragmatic herniaLung hypoplasiaMechanical ventilationPrematurityPulmonary hypertension

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