Diagnosis and management of congenital diaphragmatic hernia: a clinical practice guideline

Congenital diaphragmatic hernia: Impact of contemporary management strategies on perinatal outcomes

“…The former two were introduced in Western Australia in 1996. In the last two decades, gentle ventilation with permissive hypercapnia and aggressive treatment of pulmonary hypertension have been increasingly incorporated into standardized protocols for postnatal management of infants born with CDH . This technique was adopted by Western Australia in 2003.…”

Successful lung response after surgical repair in an infant with right-sided congenital diaphragmatic hernia

“…Prenatal diagnosis is essential in identifying and managing infants with congenital diaphragmatic hernia, especially those cases at higher risk for the worse outcomes, to optimize their clinical and surgical management [6] . Several prenatal factors may be considered in the evaluation of the defect, such as coexistence of liver herniation, the observed-to-expected lung-head ratio by ultrasound for the estimation of likelihood of pulmonary hypoplasia, and assessment of fetal lung volumes by magnetic resonance imaging [6] .…”

“…Prenatal diagnosis is essential in identifying and managing infants with congenital diaphragmatic hernia, especially those cases at higher risk for the worse outcomes, to optimize their clinical and surgical management [6] . Several prenatal factors may be considered in the evaluation of the defect, such as coexistence of liver herniation, the observed-to-expected lung-head ratio by ultrasound for the estimation of likelihood of pulmonary hypoplasia, and assessment of fetal lung volumes by magnetic resonance imaging [6] . An observed-to-expected lung-head ratio <45% has been reported to predict poor outcome in right-sided congenital diaphragmatic hernia, while an observed-to-expected lung-head ratio ≤25% predicts poor outcome in left sided congenital diaphragmatic hernia (25% survival) [6] .…”

“…Several prenatal factors may be considered in the evaluation of the defect, such as coexistence of liver herniation, the observed-to-expected lung-head ratio by ultrasound for the estimation of likelihood of pulmonary hypoplasia, and assessment of fetal lung volumes by magnetic resonance imaging [6] . An observed-to-expected lung-head ratio <45% has been reported to predict poor outcome in right-sided congenital diaphragmatic hernia, while an observed-to-expected lung-head ratio ≤25% predicts poor outcome in left sided congenital diaphragmatic hernia (25% survival) [6] . In our case, despite an observed-to-expected lung-head ratio of approximately 78%, the chest X-ray performed after birth was suggestive of pulmonary hypoplasia and a large diaphragmatic defect that needed patch repair was detected during surgical exploration.…”

“…In these patients, surgery should be deferred until clinical conditions are declared stable, thus allowing to relocate viscera into their physiological position. Depending on the size, diaphragmatic defects can be repaired primarily or, if large, a permanent patch closure is required [6] .…”