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.
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.
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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