Recent advances in the management of congenital diaphragmatic hernia

Current Opinion in Pediatrics, 05/16/2012

Rollins MD – As a result of advancements in perinatal care, more severely affected newborns with Congenital diaphragmatic hernia (CDH) are now surviving. These patients may experience a number of associated morbidities which affect not only their health but overall quality of life. A multidisciplinary approach to the long–term care of these patients will allow early identification and management of these morbidities.

Methods

  • Congenital diaphragmatic hernia (CDH) is a rare developmental defect resulting in variable degrees of lung and pulmonary vasculature hypoplasia.
  • Whereas many high-volume centers have recently reported increased survival rates, this has not been the collective trend.
  • One potential explanation for this is inconsistent perinatal care among centers.

Results

  • Significant efforts have been made to identify prenatally those fetuses that will be most severely affected.
  • A number of radiologic features have shown promise for achieving this goal as well as identifying fetuses that may benefit from prenatal intervention.
  • When CDH is antenatally diagnosed, early referral to a tertiary center is recommended.
  • Centers that routinely use postnatal management protocols have demonstrated improved overall survival rates including increased survival in high-risk CDH patients.

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