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Congenital diaphragmatic hernia: current status and review of the literature.
European Journal of Pediatrics
Treatment of congenital diaphragmatic hernia (CDH) challenges obstetricians, pediatric surgeons, and neonatologists. Persistent pulmonary hypertension (PPHT) associated with lung hypoplasia in CDH leads to a high mortality rate at birth. PPHT is principally due to an increased muscularization of the arterioles. Management of CDH has been greatly improved by the introduction of prenatal surgical intervention with tracheal obstruction (TO) and by more appropriate postnatal care. TO appears to accelerate fetal lung growth and to increase the number of capillary vessels and alveoli. Improvement of postnatal care over the last years is mainly due to the avoidance of lung injury by applying low peak inflation pressure during ventilation. The benefits of other drugs or technical improvements such as the use of inhaled nitric oxide or extracorporeal membrane oxygenation (ECMO) are still being debated and no single strategy is accepted worldwide. Despite intensive clinical and experimental research, the treatment of newborn with CDH remains difficult.
Animals, Balloon Dilatation, Calcium Channel Blockers/therapeutic use, Comorbidity, Extracorporeal Membrane Oxygenation, Fetal Diseases/diagnosis, Fetal Diseases/surgery, Fetal Therapies/methods, Fetus, Gestational Age, Guanylate Cyclase/therapeutic use, Hernia, Diaphragmatic/congenital, Hernia, Diaphragmatic/diagnosis, Humans, Infant, Newborn, Nitric Oxide/therapeutic use, Persistent Fetal Circulation Syndrome/diagnosis, Persistent Fetal Circulation Syndrome/epidemiology, Phosphoric Diester Hydrolases/therapeutic use, Pulmonary Surgical Procedures/methods, Respiration, Artificial/methods, Surface-Active Agents/therapeutic use, Tracheal Stenosis/congenital, Tracheal Stenosis/diagnosis, Treatment Outcome
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