Materiały źródłowe

• #1 Congenital Diaphragmatic Hernia (CDH) | Memorial Hermann

  https://memorialhermann.org/services/conditions/congenital-diaphragmatic-hernia

  The multidisciplinary physician team has played a major role in the continued advancement of CDH care, having cumulatively published more medical journal articles on CDH than most centers in the world, providing education on CDH by teaching courses locally and giving lectures throughout the country, and furthering research by gathering data to track long-term outcomes. […] Finding the best care means finding the best team. At Children’s Memorial Hermann Hospital (CMHH), we approach every CDH patient as a potential survivor. […] This approach has translated to higher-than-expected risk-stratified survival, as well as one of the highest rates of surgical repair in the world.

• #1 Congenital diaphragmatic hernia (CDH) in neonates | Safer Care Victoria

  https://www.safercare.vic.gov.au/best-practice-improvement/clinical-guidance/neonatal/congenital-diaphragmatic-hernia-cdh-in-neonates

  Eighty per cent of babies with congenital diaphragmatic hernia (CDH) are diagnosed prenatally and are therefore born in a tertiary hospital. […] If the unexpected birth of an infant with CDH occurs outside a tertiary hospital, resuscitation should be undertaken and supervised by the most experienced clinician available. […] Ventilation using a bag and mask should be minimised in favour of endotracheal intubation if prolonged resuscitation is required. […] Lung-protective ventilation with permissive hypercarbia and hypoxia is an important strategy in the critically ill baby with CDH. […] The high mortality rate illustrates the importance of thorough evaluation, from the time of suspected fetal diagnosis, by a multidisciplinary team familiar with all aspects of the diagnosis and management of CDH.

• #1 Congenital diaphragmatic hernia (CDH) – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/congenital-diaphragmatic-hernia/diagnosis-treatment/drc-20544259

  Treatment of congenital diaphragmatic hernia depends on when the condition is found and how serious it is. Your health care team helps you decide what’s best for you and your baby. […] An emerging treatment for severe CDH now being studied is called fetoscopic endoluminal tracheal occlusion (FETO). This surgery is done on your baby while you’re still pregnant. The goal is to help the baby’s lungs grow as much as possible before birth. […] FETO is done in two procedures: The first procedure happens early in the last few months (third trimester) of your pregnancy. Your surgeon makes a small incision in your abdomen and uterus. The surgeon inserts a special tube with a camera at the end, called a fetal endoscope, through your baby’s mouth and into the windpipe (trachea). A small balloon is placed in your baby’s trachea and inflated.

• #1 Congenital Diaphragmatic Hernia (CDH) Prenatal Treatment | Memorial Hermann

  https://memorialhermann.org/services/treatments/congenital-diaphragmatic-hernia-prenatal-treatment

  It is essential that delivery of CDH patients occurs in a hospital that is well prepared to handle the intensive care and surgery required for infants with the condition. […] Close proximity to pediatric surgical services and effective coordination among specialized teams is important to optimizing care for CDH babies. […] The delivery plan should be carefully pre-arranged and discussed between the mother and her obstetrician. […] Either a vaginal delivery or a cesarean section may be optimal for babies with CDH. […] The baby should be delivered at a hospital that is well prepared to handle the immediate intensive care and eventual surgery required for infants with CDH. […] Our ECMO team is on standby for the birth of every CDH patient.

• #1 Congenital Diaphragmatic Hernia (CDH) | Lurie Children’s

  https://www.luriechildrens.org/en/specialties-conditions/congenital-diaphragmatic-hernia/

  The first phase of the baby’s NICU care is the resuscitation and stabilization phase which begins at delivery and continues for approximately 3-5 days. […] The second phase of NICU care is the surgical phase which begins no earlier than 3 days after birth but may be delayed for several days if the baby remains unstable. […] The final phase of the NICU care for CDH babies is the feeding and growing phase. […] The vast majority of CDH babies survive and grow up to have normal, active and independent lives. […] Care by the multidisciplinary CDH team will continue after discharge from the NICU in partnership with the baby’s primary pediatrician to monitor and support the baby’s needs.

• #1 Congenital Diaphragmatic Hernia | Cardinal Glennon

  https://www.ssmhealth.com/cardinal-glennon/fetal-care-institute/fetal-conditions-we-treat/lungs/congenital-diaphragmatic-hernia/about

  Most CDH babies suffer from high blood pressure in the lungs, called pulmonary hypertension. […] CDH babies typically undergo surgery to repair the hole in their diaphragm once pulmonary hypertension has subsided. […] During the CDH repair procedure a small incision in made under the rib cage to give the surgeon access to the diaphragm and misplaced organs. […] After surgery, your baby will return to the NICU to recover and heal. […] In some cases, the pulmonary hypertension (high blood pressure in the lungs) is so severe that the blood cannot get to the lungs to exchange oxygen. […] ECMO is a machine that functions just like the heart and lungs, exchanging gases like oxygen and carbon dioxide. […] CDH is a complex condition that requires long-term follow-up care. […] Once you go home, a Collaborative CDH Care Program coordinator will assist with scheduling your baby’s follow-up clinic appointments and any future medical procedures or surgeries that may be needed.

• #1 Congenital diaphragmatic hernia (CDH) – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/congenital-diaphragmatic-hernia/diagnosis-treatment/drc-20544259

  After birth, the health care team helps you plan treatment that meets your baby’s needs. Your baby will likely be cared for in the newborn intensive care unit (NICU). […] Your baby may need to have a breathing tube. The tube is attached to a machine that helps your baby breathe. This gives the lungs and heart time to grow and develop. […] Babies who have life-threatening lung problems may need a treatment called extracorporeal membrane oxygenation (ECMO). This is also known as extracorporal life support (ECLS). The ECMO machine does the work of your baby’s heart and lungs, allowing these organs to rest and heal. […] Most babies who have CDH have surgery to close the hole in the diaphragm. When this surgery takes place depends on your baby’s health and other factors. Follow-up care to ensure the repair remains in place usually includes chest X-rays.

• #1 Diaphragmatic Hernias Treatment & Management: Approach Considerations, Medical Therapy for Congenital Diaphragmatic Hernia, Surgical Therapy for Congenital Diaphragmatic Hernia

  https://emedicine.medscape.com/article/934824-treatment

  Several considerations must be taken into account in determining the treatment approach. […] The optimal timing of CDH repair has not yet been definitively established. Ideally, the defect should be repaired when the infant is stable. However, this approach also means prolonged exposure to central venous access and extended periods of enteral starvation, which may have their own risks and complications. The optimal approach is to find a balance between repairing the defect when the infant is stable and minimizing prolonged exposure to central venous access and enteral starvation. […] Retrospective studies, though limited by selection bias, have suggested that for infants who do not require ECMO, early repair ( 48 hr) may lead to fewer ventilator days, reduced supplemental oxygen needs, and shorter hospital stays.

• #1 Congenital diaphragmatic hernia repair: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/002936.htm

  Congenital diaphragmatic hernia (CDH) repair is surgery to close an opening or space in a baby’s diaphragm. This opening is called a hernia. It is a rare type of birth defect. Congenital means the problem is present at birth. […] Until the surgery is done, and usually for some time afterwards, nearly all infants need a breathing machine to improve their oxygen levels. Many babies with CDH will require extracorporeal membrane oxygenation (ECMO), which uses a pump to circulate blood through an artificial lung and back into the bloodstream of the baby. […] The surgery is done while your child is under general anesthesia (asleep and not able to feel pain). The surgeon usually makes a cut (incision) in the belly under the lower ribs. This allows the organs in the area to be reached. The surgeon gently pulls these organs down into place through the opening in the diaphragm and into the abdominal cavity.

• #1 Congenital Diaphragmatic Hernia (CDH) | Boston Children’s Hospital

  https://www.childrenshospital.org/conditions/congenital-diaphragmatic-hernia

  After your baby is born, they will be taken to and cared for in our Medical-Surgical Intensive Care Unit (MSICU) at Boston Children’s. […] When your baby’s condition has improved, our surgeons will repair the diaphragmatic hernia with an operation. […] During the operation, the abdominal organs will be moved from the chest cavity back to the abdominal cavity and the hole in the diaphragm is closed with stitches if the opening is small, or with a patch if the opening is large or if the diaphragm is absent. […] Babies will need to remain in the MSICU for a while after surgery. […] Although the abdominal organs are now in the right place, your baby’s lungs and the blood vessels in the lungs are still underdeveloped. […] Your baby will usually need to have breathing support for a period of time after the operation.

• #1 Congenital diaphragmatic hernia (CDH) – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/congenital-diaphragmatic-hernia/diagnosis-treatment/drc-20544259

  After leaving the hospital, your baby may need extra support. This can include supplemental oxygen. Oxygen is delivered by thin plastic tubing with prongs that fit into the nostrils or thin tubing connected to a mask worn over the nose and mouth. Feeding support may also be needed to help with growth and development. Medicine may be given for conditions associated with CDH, such as acid reflux or pulmonary hypertension. […] Regular follow-up appointments with your child’s health care provider can address any problems early.

• #1 Congenital Diaphragmatic Hernia (CDH): Symptoms, Diagnosis & Treatment | Nationwide Children’s Hospital

  https://www.nationwidechildrens.org/conditions/congenital-diaphragmatic-hernia

  Other treatments your baby will most likely need after surgery are: Antibiotic medicine to prevent infection, Fluids and nutrients through the PICC, Oxygen. Some babies need to go home with oxygen, Medicines to support blood pressure in the body and lower blood pressure in the lungs, Pain medicines as needed, A chest tube to help drain fluid from the incision. […] Babies with CDH are at risk for ongoing problems with the lungs, including asthma and respiratory infections. They are also at risk for ongoing problems with feeding, gastrointestinal reflux, and developmental delays. These risks are higher in babies that need ECMO. Physical and occupation therapy and early intervention may be needed to help your child.

• #1 Congenital Diaphragmatic Hernia (CDH) | Brown University Health

  https://www.brownhealth.org/centers-services/fetal-treatment-program-new-england/conditions-we-treat/congenital-diaphragmatic

  Serious cases may need to be treated with extracorporeal membrane oxygenation (ECMO), a lung bypass machine that allows gas exchange (taking in oxygen and giving off carbon dioxide) while the baby’s lungs are resting. […] Once the baby’s condition has improved (this may take up to a week or longer), he or she will undergo surgery to move the organs into the abdomen and repair the hole in the diaphragm. […] After surgery the baby will stay in the neonatal intensive care unit until full recovery. […] The long-term outcome depends primarily on how developed the lungs are at birth. […] The baby may also require occupational therapy to improve muscle strength and coordination, especially if the baby has been very sick for several weeks and particularly if the baby has been treated with ECMO. […] To get enough nutrients, babies sometimes need additional feedings through the assistance of a feeding tube.

• #1 Recent advances in the treatment of complex congenital diaphragmatic hernia—a narrative review – Holden – Translational Pediatrics

  https://tp.amegroups.org/article/view/115367/html

  The management of infants with CDH has improved because of specific advances including pressure-limited ventilation, extracorporeal life support (ECLS), and neonatal critical care expertise. […] While the overall survival rate among patients with CDH remains approximately 65-80%, depending upon numerous factors, select groups have suggested that further improvements in survival may be achievable through specific, evidence-based, protocol-driven adoption of specific management principles. […] For high-risk patients, their measured lung volumes were found to be 39% of the controls, and those who survived had much higher volumes compared to those who did not. […] With further understanding of the pathophysiology, new management strategies are based on reducing pre-capillary pulmonary vascular resistance and optimizing lung recruitment while avoiding overdistention and de-recruitment.

• #1 Recent advances in the treatment of complex congenital diaphragmatic hernia—a narrative review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10416132/

  Congenital diaphragmatic hernia (CDH) is an anomaly of the cardiopulmonary system maturation process that results from both a global embryopathy and concomitant mechanical compression of the cardiopulmonary system from the abdominal contents during fetal maturation. […] Advances at the basic, translational, and clinical research levels are leading to novel therapies and management strategies for complex, high-risk CDH. […] The management of infants with CDH has improved because of specific advances including pressure-limited ventilation, extracorporeal life support (ECLS), and neonatal critical care expertise. […] While the overall survival rate among patients with CDH remains approximately 65-80%, depending upon numerous factors, select groups have suggested that further improvements in survival may be achievable through specific, evidence-based, protocol-driven adoption of specific management principles.

• #1 Congenital Diaphragmatic Hernia (CDH): Diagnosis & Treatment | NewYork-Presbyterian

  https://www.nyp.org/pediatrics/genetics/congenital-diaphragmatic-hernia/treatment

  Our multidisciplinary team of specialists closely monitors your child to optimize their long-term health, including: […] Congenital diaphragmatic hernia is a complicated condition that requires multidisciplinary care. Our CDH programs bring together the expertise of pediatric specialists, including pediatric surgeons, neonatologists, cardiologists, pulmonologists, gastroenterologists, orthopedists, developmental pediatricians, and psychologists. […] We work with you, your child, and your family to ensure the best possible treatment and care as your child grows.

• #2 Congenital Diaphragmatic Hernia Repair – UF Health

  https://ufhealth.org/conditions-and-treatments/congenital-diaphragmatic-hernia-repair

  UF Health Shands Childrens Hospital is one of the few childrens hospitals in the country that has a whole program based on caring for patients with congenital diaphragmatic hernia. […] We have treated over 300 CDH infants, and for patients that dont have a second life-threatening birth defect in addition to their CDH, survival approaches 90% (99% for left CDH with liver in abdomen, 92% for right CDH, and 75% for left CDH liver in chest, overall 88%. Annals of Surgery 2013). […] Our multidisciplinary team of specialists provides around-the-clock care for CDH babies, from birth to discharge, emphasizing lung protection, brain protection, and an individualized treatment strategy based on risk stratification. […] As part of an academic health system, we are actively involved in research about the treatment of CDH to increase survival rates and optimize outcomes.

• #2

  https://www.mercy.net/service/congenital-diaphragmatic-hernia-cdh/

  If your baby has a congenital diaphragmatic hernia, a fetal MRI may be used to better understand your child’s problems so appropriate treatment can be planned. […] Mercy takes a team approach to caring for babies with CDH. Together, our neonatologists and pediatric pulmonologists, cardiologists and surgeons develop a personalized treatment plans based on the severity of the condition and the babys overall health. […] Mercy offers the most advanced treatments including: […] Surgery: Our pediatric surgeons perform surgery soon after birth to gently move the abdominal organs out of the chest and back into their correct place, then close the opening in the diaphragm. After surgery, babies recover in our Neonatal Intensive Care Unit (NICU), where they receive round-the-clock expert monitoring and nurturing care. […] Fortunately, most children born with CDH will have no long-term problems. Mercys expert, compassionate specialists are dedicated to helping your baby recover from CDH and live a healthy life.

• #2 Congenital Diaphragmatic Hernia (CDH)

  https://fetus.ucsf.edu/cdh/

  The surgery to repair diaphragmatic hernia after birth is not an emergency and is usually performed when the baby has stabilized, usually within the first week of life. […] Babies with CDH should be delivered in an experienced tertiary perinatal center with ECMO capability. […] The most promising uses FETENDO fetal surgery, specifically a fetoscopic temporary tracheal occlusion to enlarge the fetal lung. […] Balloon tracheal occlusion is only offered to those patients whose fetus have the most severe form of congenital diaphragmatic hernia. […] If you are found to be a tracheal occlusion candidate, and you chose to undergo the procedure, the tracheal occlusion operation will be performed between the 26th and 28th week of your pregnancy. […] Babies with CDH should be delivered at a tertiary perinatal center with a high-level intensive care nursery and pediatric surgery. […] The long-term outcome depends on the severity of the CDH and the need for very intensive support. […] Anticipation and management of health problems associated with CDH and other birth defects is the main focus of the LIFE clinic.

• #2 Diagnosis and management of congenital diaphragmatic hernia: a 2023 update from the Canadian Congenital Diaphragmatic Hernia Collaborative | ADC Fetal & Neonatal Edition

  https://fn.bmj.com/content/109/3/239

  The updated care guidelines still allow for innovation and continued advancement in CDH care. […] Delivery is recommended in a tertiary care centre with neonatal intensive care unit (NICU) and paediatric surgery expertise in CDH management, as outborn delivery is a significant predictor of mortality. […] Due to the significant morbidity and mortality associated with CDH, fetal interventions aimed at improving lung development in utero have been investigated. […] Based on these studies, FETO is an option for severe, and possibly moderate risk CDH in selected patients, with more research required for its use in infants with moderate CDH. […] The use of targeted pulmonary vasodilator therapy is recommended in the context of CDH-associated pulmonary hypertension when standard cardiorespiratory manoeuvres fail to maintain adequate oxygenation or cardiac function.

• #2 Congenital Diaphragmatic Hernia | Fetal Care Center | Connecticut Children’s

  https://www.connecticutchildrens.org/specialties-conditions/fetal-care-center/fetal-care-conditions/congenital-diaphragmatic-hernia

  The goal of CDH management in the first hours and days of life is to prevent an acute pulmonary hypertensive crisis by making sure the baby is protected from all noxious stimuli including pain, loud noises, and bright lights. […] Prenatal CDH-CPI helps guide the anticipated timing of CDH repair. […] In mild cases of CDH, this level is usually reached by the end of the first week of life. […] In moderately severe cases it may take about 2 weeks to reach this level. […] In severe cases, it may take more than 3 weeks to reach this level, and we have waited up to 2 months to repair the defect. […] The advantage of using echocardiographic criteria for the timing of repair is that it statistically significantly improves survival compared to approaches that do not take pulmonary pressure estimates into consideration.

• #2 Recent advances in the treatment of complex congenital diaphragmatic hernia—a narrative review – Holden – Translational Pediatrics

  https://tp.amegroups.org/article/view/115367/html

  The use of pulmonary vasodilator therapies like Sildenafil, Bosentan, Epoprostenol, prostaglandin E1 (PGE1), and milrinone have aided in the reduction of the right ventricular (RV) afterload while maintaining systemic blood flow. […] The first is the timing for umbilical cord clamping. The current practice of umbilical cord clamping before lung aeration and perinatal stabilization may contribute to worsening pulmonary hypertension. […] The use of PGE1 has also altered the management of pulmonary hypertension in CDH infants. […] Antenatal interventions like FETO have evolved to become a promising adjunct to the treatment of CDH. […] The FETO procedure occludes the trachea and prevents the regression of pulmonary fluid forcing pulmonary tissue and pulmonary vasculature into a hyperplastic state, ultimately causing growth and expansion to the alveoli and vasculature. […] These studies are just a start to how targeted therapy may improve the outcomes in high-risk CDH and offer a window for translationally relevant therapies to impact clinical interventions.

• #2 Congenital Diaphragmatic Hernia (CDH) | Boston Children’s Hospital

  https://www.childrenshospital.org/conditions/congenital-diaphragmatic-hernia

  How is a CDH treated? […] Every child with a CDH is unique, so treatment can vary based on the level of severity of the CDH, related anomalies, and other factors. […] At Boston Children’s, our team in the Fetal Care and Surgery Center assists in the careful management of the mother’s pregnancy and delivery, as well as the stabilization of the baby at birth and postnatal treatment. This comprehensive, multidisciplinary care has resulted in high success rates. […] Our surgical team is present at the delivery to assist the obstetrician and immediately begin care of your child. Your baby will require a breathing tube and be placed on a breathing machine called a mechanical ventilator before transport to Boston Children’s. […] Extracorporeal membrane oxygenation (ECMO) is a heart and lung bypass system that does the job that the heart and lungs would be doing if they developed fully. ECMO may be needed to support your baby’s heart and lungs if they are unable to do so until your baby’s condition stabilizes and improves. Having your baby at a hospital like Boston Children’s that is equipped with ECMO is vitally important to aid in the management of CDH.

• #2 Congenital Diaphragmatic Hernia (CDH): Symptoms, Diagnosis & Treatment | Nationwide Children’s Hospital

  https://www.nationwidechildrens.org/conditions/congenital-diaphragmatic-hernia

  All babies with CDH will need surgery after birth, but surgery may not be done right away. It is very important to make sure the babys breathing is stable and manage the high blood pressure in the lungs before going to surgery. Surgery may be done as early as 2 to 3 days after birth, or as late at 4 to 6 weeks after birth. It is typically done 1 to 2 weeks after birth. […] Once the baby is stable, they will have surgery. While surgery is needed, it may not be done for days or weeks. When your baby is ready for surgery, the surgeon will decide the best way to move the intestines back into the belly and close the hole in the diaphragm to keep everything in place. […] After surgery, your baby will keep getting care in the NICU. Your baby will need to be on a breathing machine until they are fully recovered from surgery and they can breathe on their own.

• #2 Congenital Diaphragmatic Hernia (CDH) | Columbia Surgery

  https://columbiasurgery.org/conditions-and-treatments/congenital-diaphragmatic-hernia-cdh

  Once the baby has stabilized, CDH can be surgically repaired. The shifted organs will be repositioned and the opening will be repaired. The method used is determined by the size of the opening and condition of the diaphragm. […] A pediatric surgeon will evaluate the size and location of the opening to determine the best method for repair. In some cases, CDH can be repaired using minimally invasive techniques like video-assisted thoracoscopic surgery (VATS).

• #2 Congenital Diaphragmatic Hernia (CDH): Symptoms, Diagnosis & Treatment | Nationwide Children’s Hospital

  https://www.nationwidechildrens.org/conditions/congenital-diaphragmatic-hernia

  Other treatments your baby will most likely need after surgery are: Antibiotic medicine to prevent infection, Fluids and nutrients through the PICC, Oxygen. Some babies need to go home with oxygen, Medicines to support blood pressure in the body and lower blood pressure in the lungs, Pain medicines as needed, A chest tube to help drain fluid from the incision. […] Babies with CDH are at risk for ongoing problems with the lungs, including asthma and respiratory infections. They are also at risk for ongoing problems with feeding, gastrointestinal reflux, and developmental delays. These risks are higher in babies that need ECMO. Physical and occupation therapy and early intervention may be needed to help your child.

• #2 CDH (Congenital Diaphragmatic Hernia)

  https://www.massgeneral.org/children/congenital-diaphragmatic-hernia/cdh

  All babies with CDH will need specialized care after birth, which is why it is important that the baby is delivered in a hospital with extensive postnatal care capabilities. […] Most babies with CDH are delivered vaginally. It is difficult to predict how much support a baby with CDH will need after birth. Depending on the severity of their condition, your newborn may need one or more of the following interventions: Nitric oxide is a gas that can help relax the blood vessels in your baby’s lungs and lower blood pressure. It is used to manage pulmonary hypertension. […] Babies with CDH will need a congenital diaphragmatic hernia repair surgery to move their abdominal organs back to the correct location and close the hole in their diaphragm. […] After surgery, the baby will be on a breathing machine and need to be monitored and cared for in the hospital for several weeks.

• #2 Congenital Diaphragmatic Hernia (CDH) | Brown University Health

  https://www.brownhealth.org/centers-services/fetal-treatment-program-new-england/conditions-we-treat/congenital-diaphragmatic

  Serious cases may need to be treated with extracorporeal membrane oxygenation (ECMO), a lung bypass machine that allows gas exchange (taking in oxygen and giving off carbon dioxide) while the baby’s lungs are resting. […] Once the baby’s condition has improved (this may take up to a week or longer), he or she will undergo surgery to move the organs into the abdomen and repair the hole in the diaphragm. […] After surgery the baby will stay in the neonatal intensive care unit until full recovery. […] The long-term outcome depends primarily on how developed the lungs are at birth. […] The baby may also require occupational therapy to improve muscle strength and coordination, especially if the baby has been very sick for several weeks and particularly if the baby has been treated with ECMO. […] To get enough nutrients, babies sometimes need additional feedings through the assistance of a feeding tube.

• #2 Congenital Diaphragmatic Hernia Clinic | Phoenix Children’s Hospital

  https://phoenixchildrens.org/specialties-conditions/congenital-diaphragmatic-hernia-clinic

  Children with CDH come to the NICU right after they are born. The Phoenix Childrens Level IV NICU offers the highest level of care for newborns with health problems. Our expert team of neonatologists, pediatric specialists and dedicated NICU nurses all have extensive experience in managing the most critically ill newborns. […] Our surgical team is highly skilled and experienced in procedures to repair CDH. They will discuss with you the different surgical approaches, including minimally invasive techniques. Some children need more than one surgery to reach their best recovery from CDH. […] The specialists in our pulmonology team are experts at diagnosing and treating a wide range of lung issues that can affect children with CDH. […] Phoenix Childrens has a strong team of developmental pediatric therapists who can assess your child and provide targeted therapy to help with their development. This may include physical therapy, occupational therapy and feeding therapy.

• #2 Congenital Diaphragmatic Hernia (CDH): Diagnosis and Treatment

  https://www.bannerhealth.com/services/maternity/programs-care/fetal-care-program/congenital-diaphragmatic-hernia

  The good news is that medical advancements have greatly improved CDH care. Overall, 65%-70% of babies with CDH will not only survive, but with proper care go on to meet normal growth and development milestones by kindergarten (age 5). […] Specialized medical care can help with these challenges and support the child’s overall development and quality of life. […] We are here to not only give your baby the best medical care, but also offer you emotional support and reliable information. Our goal is to ensure your family’s well-being and work together as a team to make smart decisions for your child’s care. […] Banner Healths Fetal Care Program is a leader in providing medical care for babies with CDH. Our team offers an unmatched level of care from diagnosis through delivery to the NICU and adulthood. We are here for you and your baby every step of the way.

• #2 Golden hour management of infants with congenital diaphragmatic hernia: 15 year experience at a high-volume center | Journal of Perinatology

  https://www.nature.com/articles/s41372-025-02226-z

  To review the evolution of golden hour management and outcomes for infants with congenital diaphragmatic hernia (CDH). […] Management of infants with CDH continues to evolve with ongoing experience at our high-volume center. Despite increasing severity of illness, survival outcomes have improved over time. […] Effective delivery room (DR) resuscitation of infants with CDH is complex and requires critical interventions to occur simultaneously or in quick succession. Rapid intubation and early gentle ventilation optimize gas exchange and are associated with improved survival. […] Notable changes to golden hour management for infants with CDH included lower initial fraction of inspired oxygen, severity-specific DR algorithms including HFOV as the initial mode of ventilation in severe CDH, and reduction of empiric inhaled nitric oxide.

• #2 CDH Center for Infants and Children | Rady Children’s Hospital

  https://www.rchsd.org/programs-services/comprehensive-congenital-diaphragmatic-hernia-center/

  ECMO (extracorporeal membrane oxygenation), therapy may also be recommended which is a heart-lung bypass treatment that can allow time for pulmonary hypertension to improve. Other treatments include inhaled nitric oxide and Heliox, an inhaled helium-oxygen mixture that improves the removal of carbon dioxide and eases the work of breathing. […] For babies with CDH, a pediatrician is needed to coordinate care from multiple specialists. At Rady Childrens Hospital, we take a multidisciplinary approach to provide your child with advanced care from a highly skilled team of healthcare professionals, ensuring that babies receive the best possible treatment and personalized care.

• #3 Congenital Diaphragmatic Hernia (CDH) | Boston Children’s Hospital

  https://www.childrenshospital.org/conditions/congenital-diaphragmatic-hernia

  How is a CDH treated? […] Every child with a CDH is unique, so treatment can vary based on the level of severity of the CDH, related anomalies, and other factors. […] At Boston Children’s, our team in the Fetal Care and Surgery Center assists in the careful management of the mother’s pregnancy and delivery, as well as the stabilization of the baby at birth and postnatal treatment. This comprehensive, multidisciplinary care has resulted in high success rates. […] Our surgical team is present at the delivery to assist the obstetrician and immediately begin care of your child. Your baby will require a breathing tube and be placed on a breathing machine called a mechanical ventilator before transport to Boston Children’s. […] Extracorporeal membrane oxygenation (ECMO) is a heart and lung bypass system that does the job that the heart and lungs would be doing if they developed fully. ECMO may be needed to support your baby’s heart and lungs if they are unable to do so until your baby’s condition stabilizes and improves. Having your baby at a hospital like Boston Children’s that is equipped with ECMO is vitally important to aid in the management of CDH.

• #3 Congenital Diaphragmatic Hernia – Conditions and Treatments | Children’s National Hospital

  https://www.childrensnational.org/get-care/health-library/congenital-diaphragmatic-hernia

  Treatment typically includes: Specialized breathing assistance, Extracorporeal membrane oxygenation (ECMO), Surgery. […] In almost all cases, CDHs are repaired after your baby is born. The Critical Care Delivery Program of the Zickler Family Prenatal Pediatrics Institute at Childrens National will develop a carefully organized delivery plan to ensure that your baby receives quick treatment after birth for any respiratory problems. […] Among the treatment options we offer for CDHs are: Specialized breathing assistance through use of ventilators and medications, Extracorporeal membrane oxygenation (ECMO), a bypass method to ensure that your baby receives enough oxygen after birth to allow for stabilization prior to surgical repair, Surgery to replace the herniated organs into the abdomen and to repair the hole in the diaphragm. Although most cases are not currently treated with neonatal laparoscopic surgery, you may also want to familiarize yourself with this approach. […] The Critical Care Delivery Program specialists, surgeons and neonatologists at our Prenatal Pediatrics Institute have extensive experience in the management of CDH. We develop plans that ensure continuity of care from the early stages of pregnancy, after birth, and across childhood.

• #3 Diaphragmatic Hernias Treatment & Management: Approach Considerations, Medical Therapy for Congenital Diaphragmatic Hernia, Surgical Therapy for Congenital Diaphragmatic Hernia

  https://emedicine.medscape.com/article/934824-treatment

  Studies using a fetal lamb model of CDH confirmed the feasibility of FETO. […] In the TOTAL trial, criteria for FETO included the following: Maternal age 18 years, Singleton pregnancy, Gestational age 29 weeks and 6 days, Isolated left-sided CDH, Severe pulmonary hypoplasia (O/E LHR 25%). […] In cases of catecholamine-resistant shock, vasopressin may be more effective, inducing vasoconstriction through V1, V2, and V3 receptor activation.

• #3 Diagnosis and management of congenital diaphragmatic hernia: a 2023 update from the Canadian Congenital Diaphragmatic Hernia Collaborative | ADC Fetal & Neonatal Edition

  https://fn.bmj.com/content/109/3/239

  The updated care guidelines still allow for innovation and continued advancement in CDH care. […] Delivery is recommended in a tertiary care centre with neonatal intensive care unit (NICU) and paediatric surgery expertise in CDH management, as outborn delivery is a significant predictor of mortality. […] Due to the significant morbidity and mortality associated with CDH, fetal interventions aimed at improving lung development in utero have been investigated. […] Based on these studies, FETO is an option for severe, and possibly moderate risk CDH in selected patients, with more research required for its use in infants with moderate CDH. […] The use of targeted pulmonary vasodilator therapy is recommended in the context of CDH-associated pulmonary hypertension when standard cardiorespiratory manoeuvres fail to maintain adequate oxygenation or cardiac function.

• #3 Congenital diaphragmatic hernia (CDH) – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/congenital-diaphragmatic-hernia/diagnosis-treatment/drc-20544259

  After birth, the health care team helps you plan treatment that meets your baby’s needs. Your baby will likely be cared for in the newborn intensive care unit (NICU). […] Your baby may need to have a breathing tube. The tube is attached to a machine that helps your baby breathe. This gives the lungs and heart time to grow and develop. […] Babies who have life-threatening lung problems may need a treatment called extracorporeal membrane oxygenation (ECMO). This is also known as extracorporal life support (ECLS). The ECMO machine does the work of your baby’s heart and lungs, allowing these organs to rest and heal. […] Most babies who have CDH have surgery to close the hole in the diaphragm. When this surgery takes place depends on your baby’s health and other factors. Follow-up care to ensure the repair remains in place usually includes chest X-rays.

• #3 Congenital Diaphragmatic Hernia | Conditions | UCSF Benioff Children’s Hospitals

  https://www.ucsfbenioffchildrens.org/conditions/congenital-diaphragmatic-hernia

  There is a wide range of severity and outcomes for CDH. In the best cases, some infants do very well with routine neonatal care and surgical treatment after birth. […] Even when the CDH is severe, however, more than 70 percent of affected babies can be saved with intensive support. […] Babies with severe CDH need very skilled intensive care: high-frequency oscillatory ventilation, inhaled nitric oxide and, in some cases, extracorporeal membrane oxygenation (ECMO). […] The surgery to repair CDH after birth is usually performed after the baby has stabilized in the first week of life. […] If the opening in the diaphragm is small and there is enough diaphragmatic muscle, the hole can be sewn closed. This is called a primary repair. […] In select circumstances, infants may be a candidate for a minimally invasive thoracoscopic repair. […] We recommend seeing your child’s pediatrician within one week of leaving the hospital. […] Some children will need another operation or operations later on, to repair a recurrence of the CDH.

• #3 Congenital Diaphragmatic hernia – a review | Maternal Health, Neonatology and Perinatology | Full Text

  https://mhnpjournal.biomedcentral.com/articles/10.1186/s40748-017-0045-1

  Congenital Diaphragmatic hernia (CDH) is a condition characterized by a defect in the diaphragm leading to protrusion of abdominal contents into the thoracic cavity interfering with normal development of the lungs. […] Immediate management at birth includes bowel decompression, avoidance of mask ventilation and endotracheal tube placement if required. The main focus of management includes gentle ventilation, hemodynamic monitoring and treatment of pulmonary hypertension followed by surgery. […] Extracorporeal membrane oxygenation (ECMO) is typically considered after failure of conventional medical management for infants 34 weeks gestation or with weight 2 kg with CDH and no associated major lethal anomalies. […] With advances in the management of CDH, the overall survival has improved and has been reported to be 70-90% in non-ECMO infants and up to 50% in infants who undergo ECMO.

• #3 Management advances for congenital diaphragmatic hernia: integrating prenatal and postnatal perspectives – Baschat – Translational Pediatrics

  https://tp.amegroups.org/article/view/123659/html

  Optimal CDH care is initiated prenatally. As part of the prenatal severity assessment, parents have the opportunity to gather in-depth information on postnatal management strategies and expected outcomes from a range of pediatric experts that form the CDH management team. Prenatal surveillance of fetal growth and development is important. For patients that experience polyhydramnios and preterm labor, amnioreduction and medical management can prevent premature delivery. In preparation for delivery maternal administration of a course of betamethasone or dexamethasone to enhance fetal lung maturity should be considered in alignment with current society recommendations. Key elements of a CDH delivery are the swift establishment of a reliable airway to maximize the likelihood for control of ventilation pressures after birth, and gastric decompression to maximize lung excursion.

• #3 CDH Center for Infants and Children | Rady Children’s Hospital

  https://www.rchsd.org/programs-services/comprehensive-congenital-diaphragmatic-hernia-center/

  The medical and surgical teams work closely to determine the optimal timing of the surgical repair for CDH patients. After your child recovers, CDH care will shift to include the developmental skills of your baby under the supervision of our physical therapists and occupational therapists. […] Most babies with CDH will need a breathing tube and may need help from a ventilator for many weeks. Your baby will be seen by a neonatologist and a pediatric surgeon. Consults to other specialties including genetics, cardiology, pulmonary hypertension, pulmonology, and gastroenterology will occur as needed. […] Once your baby is fit for surgery, our healthcare professionals will then repair the hole in the diaphragm and replace the intestines and other organs back in the abdomen. The timing of repair will be carefully decided based on your babys individual case.

• #3 Congenital Diaphragmatic Hernia (CDH) | Boston Children’s Hospital

  https://www.childrenshospital.org/conditions/congenital-diaphragmatic-hernia

  Even after your baby no longer needs help from a breathing machine, they may still need oxygen and medications to help with breathing for weeks, months, or years. […] Pulmonary hypertension (poorly developed blood vessels in the lungs) may persist requiring ongoing treatment. […] Nutrition is important for your baby’s lung and overall growth. […] Before your baby is discharged, we conduct many tests to make sure that all of their systems are working well. […] A diaphragmatic hernia is a complex health concern that requires long-term follow-up. Our outpatient multidisciplinary CDH clinic monitors and treats children born with CDH. […] Boston Children’s treats more than 20 newborns with CDH each year with a success rate among the best in the world. […] Our survival rate for the highest risk groups of babies with CDH is consistently 10 percent higher than that of other centers dedicated to treating this condition.

• #3 Congenital diaphragmatic hernia repair: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/002936.htm

  Usually the outlook is good for infants who have well-developed lung tissue and no other problems. Even so, most babies who are born with a diaphragmatic hernia are very ill and will stay in the hospital for a long time. With advances in medicine, the outlook for these infants is improving. […] All babies who have had CDH repairs will need to be watched closely to make sure the hole in their diaphragm does not open up again as they grow.

• #3 Congenital Diaphragmatic Hernia (CDH) | Brown University Health

  https://www.brownhealth.org/centers-services/fetal-treatment-program-new-england/conditions-we-treat/congenital-diaphragmatic

  Serious cases may need to be treated with extracorporeal membrane oxygenation (ECMO), a lung bypass machine that allows gas exchange (taking in oxygen and giving off carbon dioxide) while the baby’s lungs are resting. […] Once the baby’s condition has improved (this may take up to a week or longer), he or she will undergo surgery to move the organs into the abdomen and repair the hole in the diaphragm. […] After surgery the baby will stay in the neonatal intensive care unit until full recovery. […] The long-term outcome depends primarily on how developed the lungs are at birth. […] The baby may also require occupational therapy to improve muscle strength and coordination, especially if the baby has been very sick for several weeks and particularly if the baby has been treated with ECMO. […] To get enough nutrients, babies sometimes need additional feedings through the assistance of a feeding tube.

• #3 Management of Congenital Diaphragmatic Hernia (CDH): Role of Molecular Genetics

  https://www.mdpi.com/1422-0067/22/12/6353

  This review of the literature provides an overview of current knowledge of normal diaphragm embryogenesis and a summary of genetic mutations as well as related pathways and cellular mechanisms involved in CDH whose knowledge is essential to the development of new therapeutic strategies and evidence-based genetic counselling to parents. […] The prognosis of isolated CDH is better than CDH associated with multiple abnormalities; a higher survival rate has also been demonstrated for the former. […] Prenatal diagnosis of CDH is possible as early as 12 weeks of gestation during first trimester ultrasound screen; CDH ultrasound detection is successful in 50% of cases at a mean gestational age of 24 weeks. […] The presence of associated abnormalities, particularly heart disease, extent of pulmonary hypoplasia, and liver position (intra-abdominal or intrathoracic) are the main determinants of CDH outcomes.

• #3 Recent advances in the treatment of complex congenital diaphragmatic hernia—a narrative review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10416132/

  The development of risk-stratification processes, best practices or guidelines of management, and novel therapies is critical to optimize the care of these infants. […] The use of pulmonary vasodilator therapies like Sildenafil, Bosentan, Epoprostenol, prostaglandin E1 (PGE1), and milrinone have aided in the reduction of the right ventricular (RV) afterload while maintaining systemic blood flow. […] The first is the timing for umbilical cord clamping. […] The use of PGE1 has also altered the management of pulmonary hypertension in CDH infants. […] The FETO procedure occludes the trachea and prevents the regression of pulmonary fluid forcing pulmonary tissue and pulmonary vasculature into a hyperplastic state, ultimately causing growth and expansion to the alveoli and vasculature. […] These studies provide early evidence that ventricular function is a key determinant of disease severity and highlight that it is emerging as an important predictor of outcome but leave the field open to further investigation. […] In conclusion, neonates with high-risk CDH, including the severe patients on the isolated CDH spectrum, along with those who have a CDH plus an associated anomaly, require special consideration and benefit from nuanced, multidisciplinary management.

• #3 CDH (Congenital Diaphragmatic Hernia)

  https://www.massgeneral.org/children/congenital-diaphragmatic-hernia/cdh

  CDH is a rare birth defect that causes an opening in the muscle between the chest and abdomen and allows the abdominal organs to be displaced into the chest. This affects the development of the baby’s lungs. […] Babies with CDH are treated with breathing help for their small lungs, and then surgery to repair the hole and move the organs back into the correct place. […] Many different factors will determine the course of treatment for your baby. You will be guided in the decision-making process by a multidisciplinary team of specialists experienced with treating CDH. […] Fetal surgery is a treatment option that can be performed during pregnancy. Fetuses with severe liver herniation and extremely poor lung growth may be candidates for a minimally invasive experimental procedure called fetoscopic tracheal occlusion or FETO.

• #4 Recent advances in the treatment of complex congenital diaphragmatic hernia—a narrative review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10416132/

  Congenital diaphragmatic hernia (CDH) is an anomaly of the cardiopulmonary system maturation process that results from both a global embryopathy and concomitant mechanical compression of the cardiopulmonary system from the abdominal contents during fetal maturation. […] Advances at the basic, translational, and clinical research levels are leading to novel therapies and management strategies for complex, high-risk CDH. […] The management of infants with CDH has improved because of specific advances including pressure-limited ventilation, extracorporeal life support (ECLS), and neonatal critical care expertise. […] While the overall survival rate among patients with CDH remains approximately 65-80%, depending upon numerous factors, select groups have suggested that further improvements in survival may be achievable through specific, evidence-based, protocol-driven adoption of specific management principles.

• #4 Congenital Diaphragmatic Hernia (CDH) | Boston Children’s Hospital

  https://www.childrenshospital.org/conditions/congenital-diaphragmatic-hernia

  How is a CDH treated? […] Every child with a CDH is unique, so treatment can vary based on the level of severity of the CDH, related anomalies, and other factors. […] At Boston Children’s, our team in the Fetal Care and Surgery Center assists in the careful management of the mother’s pregnancy and delivery, as well as the stabilization of the baby at birth and postnatal treatment. This comprehensive, multidisciplinary care has resulted in high success rates. […] Our surgical team is present at the delivery to assist the obstetrician and immediately begin care of your child. Your baby will require a breathing tube and be placed on a breathing machine called a mechanical ventilator before transport to Boston Children’s. […] Extracorporeal membrane oxygenation (ECMO) is a heart and lung bypass system that does the job that the heart and lungs would be doing if they developed fully. ECMO may be needed to support your baby’s heart and lungs if they are unable to do so until your baby’s condition stabilizes and improves. Having your baby at a hospital like Boston Children’s that is equipped with ECMO is vitally important to aid in the management of CDH.

• #4 Congenital Diaphragmatic Hernia (CDH) | Brown University Health

  https://www.brownhealth.org/centers-services/fetal-treatment-program-new-england/conditions-we-treat/congenital-diaphragmatic

  Most babies with CDH are best treated after birth; however, fetal intervention is possible for the most severe cases. […] One option is fetal tracheal occlusion, a minimally invasive operation performed on the fetus that treats CDH by promoting natural lung growth. […] In one large study (the Eurofoetus consortium), this procedure increased survival rates from 10-40 percent to 40-80 percent. […] The outcome of mild cases of CDH when the lungs are nearly the proper size and the liver is completely in the abdomen is often very good at birth. […] In severe cases, the baby may require aggressive resuscitation immediately. […] No matter the prognosis, it is recommended that mothers deliver in a tertiary center that has immediate access to a specialized neonatal intensive care unit (NICU) and to advanced technology, such as extracorporeal membrane oxygenation, with a pediatric surgical specialist present.

• #4 Congenital Diaphragmatic Hernia (CDH) | Lurie Children’s

  https://www.luriechildrens.org/en/specialties-conditions/congenital-diaphragmatic-hernia/

  The multidisciplinary CDH team uses care protocols based on the latest scientific evidence. These care protocols have been optimized through the clinical experience of caring for several hundred mothers and babies with a prenatal diagnosis of CDH and result in the best possible outcomes. […] In the most severe forms of CDH, a surgical intervention called Fetoscopic Endoluminal Tracheal Occlusion (FETO) may be recommended to improve the baby’s outcome. FETO is an innovative treatment option that helps the baby’s lungs to develop as much as possible before birth. […] The delivery management depends on several factors, including the severity of the CDH and obstetrical needs for the mother. A term vaginal delivery is typically recommended unless obstetrical needs suggest that an alternative approach would be beneficial to the mother or the baby.

• #4 Congenital Diaphragmatic Hernia (CDH): Symptoms, Diagnosis & Treatment | Nationwide Children’s Hospital

  https://www.nationwidechildrens.org/conditions/congenital-diaphragmatic-hernia

  Other treatments your baby will most likely need after surgery are: Antibiotic medicine to prevent infection, Fluids and nutrients through the PICC, Oxygen. Some babies need to go home with oxygen, Medicines to support blood pressure in the body and lower blood pressure in the lungs, Pain medicines as needed, A chest tube to help drain fluid from the incision. […] Babies with CDH are at risk for ongoing problems with the lungs, including asthma and respiratory infections. They are also at risk for ongoing problems with feeding, gastrointestinal reflux, and developmental delays. These risks are higher in babies that need ECMO. Physical and occupation therapy and early intervention may be needed to help your child.

• #4 Recent advances in the treatment of complex congenital diaphragmatic hernia—a narrative review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10416132/

  The development of risk-stratification processes, best practices or guidelines of management, and novel therapies is critical to optimize the care of these infants. […] The use of pulmonary vasodilator therapies like Sildenafil, Bosentan, Epoprostenol, prostaglandin E1 (PGE1), and milrinone have aided in the reduction of the right ventricular (RV) afterload while maintaining systemic blood flow. […] The first is the timing for umbilical cord clamping. […] The use of PGE1 has also altered the management of pulmonary hypertension in CDH infants. […] The FETO procedure occludes the trachea and prevents the regression of pulmonary fluid forcing pulmonary tissue and pulmonary vasculature into a hyperplastic state, ultimately causing growth and expansion to the alveoli and vasculature. […] These studies provide early evidence that ventricular function is a key determinant of disease severity and highlight that it is emerging as an important predictor of outcome but leave the field open to further investigation. […] In conclusion, neonates with high-risk CDH, including the severe patients on the isolated CDH spectrum, along with those who have a CDH plus an associated anomaly, require special consideration and benefit from nuanced, multidisciplinary management.

• #4 Treatments and Services | Congenital Diaphragmatic Hernia (CDH) Program

  https://www.cincinnatichildrens.org/service/c/cdh/treatments-services

  If you need high-risk obstetric care, you get expert guidance and treatment from our OB Clinic. […] We offer special delivery procedures that ensure your baby can breathe after delivery. Ex utero intrapartum treatment (EXIT) establishes an airway while your baby continues to receive oxygen from the placenta. […] In severe cases of CDH, we perform EXIT-to-ECMO. […] This procedure can improve survival up to 65% for babies with the most severe cases of CDH. […] Your baby will spend time in the NICU after birth. We provide advanced care to help the lungs develop, reduce other complications, and improve your babys chance of survival. […] Most babies with CDH need surgery to close the hole in the diaphragm and place abdominal organs in the correct location within the body. […] We perform the surgical repair days or weeks after birth.

• #4 Congenital Diaphragmatic Hernia | Fetal Care Center | Connecticut Children’s

  https://www.connecticutchildrens.org/specialties-conditions/fetal-care-center/fetal-care-conditions/congenital-diaphragmatic-hernia

  The goal of CDH management in the first hours and days of life is to prevent an acute pulmonary hypertensive crisis by making sure the baby is protected from all noxious stimuli including pain, loud noises, and bright lights. […] Prenatal CDH-CPI helps guide the anticipated timing of CDH repair. […] In mild cases of CDH, this level is usually reached by the end of the first week of life. […] In moderately severe cases it may take about 2 weeks to reach this level. […] In severe cases, it may take more than 3 weeks to reach this level, and we have waited up to 2 months to repair the defect. […] The advantage of using echocardiographic criteria for the timing of repair is that it statistically significantly improves survival compared to approaches that do not take pulmonary pressure estimates into consideration.

• #4 Treatments and Services | Congenital Diaphragmatic Hernia (CDH) Program

  https://www.cincinnatichildrens.org/service/c/cdh/treatments-services

  We use a minimally invasive approach such as thoracoscopy to access the chest and abdomen. […] After surgery, your baby is placed on ECMO. […] Some babies with severe CDH also have other conditions and anomalies. […] The experts at Cincinnati Childrens are highly experienced in managing all conditions related to CDH. […] We also offer long-term, follow-up programs to help your child reach their full potential.

• #4 Congenital Diaphragmatic Hernia | Children’s Wisconsin

  https://childrenswi.org/medical-care/fetal-concerns-center/conditions/infant-complications/congenital-diaphragmatic-hernia

  We also will place an arterial line called an umbilical artery catheter (UAC) in one of the arteries of the umbilical cord. We use this line to give IV fluid, remove blood for testing and monitor blood pressure. […] Some medications your baby may need before surgery include: Narcotics to keep your baby free from pain, Paralytics to keep your baby from moving, Blood pressure medication to maintain an adequate blood pressure or decrease abnormally high blood pressure in the heart and lungs. […] After surgery your baby will need continued assistance to breathe effectively. He or she will need frequent lab work to monitor oxygenation, electrolytes and blood counts. […] After surgery your baby may need a variety of medications including: Antibiotics to fight infection, Pain medication to control pain after surgery, Blood pressure medication to stabilize and maintain an adequate blood pressure, Sedation to keep your baby calm, Paralytics to keep your baby from moving.

• #4 Congenital Diaphragmatic Hernia (CDH): Diagnosis & Treatment | NewYork-Presbyterian

  https://www.nyp.org/pediatrics/genetics/congenital-diaphragmatic-hernia/treatment

  Our multidisciplinary team of specialists closely monitors your child to optimize their long-term health, including: […] Congenital diaphragmatic hernia is a complicated condition that requires multidisciplinary care. Our CDH programs bring together the expertise of pediatric specialists, including pediatric surgeons, neonatologists, cardiologists, pulmonologists, gastroenterologists, orthopedists, developmental pediatricians, and psychologists. […] We work with you, your child, and your family to ensure the best possible treatment and care as your child grows.

• #4 Diagnosis and management of congenital diaphragmatic hernia: a 2023 update from the Canadian Congenital Diaphragmatic Hernia Collaborative | ADC Fetal & Neonatal Edition

  https://fn.bmj.com/content/109/3/239

  Gastro-oesophageal reflux disease (GERD) is extremely prevalent with formal impedance testing demonstrating persistence of GERD in 60% of infants with CDH beyond 1year of age. […] This updated CPG provides an evidence-based and consensus-driven management framework that aims to improve outcomes and encourage synthesis of new knowledge through targeted research and quality improvement efforts.

• #4 Congenital Diaphragmatic Hernia (CDH) | Brown University Health

  https://www.brownhealth.org/centers-services/fetal-treatment-program-new-england/conditions-we-treat/congenital-diaphragmatic

  Serious cases may need to be treated with extracorporeal membrane oxygenation (ECMO), a lung bypass machine that allows gas exchange (taking in oxygen and giving off carbon dioxide) while the baby’s lungs are resting. […] Once the baby’s condition has improved (this may take up to a week or longer), he or she will undergo surgery to move the organs into the abdomen and repair the hole in the diaphragm. […] After surgery the baby will stay in the neonatal intensive care unit until full recovery. […] The long-term outcome depends primarily on how developed the lungs are at birth. […] The baby may also require occupational therapy to improve muscle strength and coordination, especially if the baby has been very sick for several weeks and particularly if the baby has been treated with ECMO. […] To get enough nutrients, babies sometimes need additional feedings through the assistance of a feeding tube.

• #4 Recent advances in the treatment of complex congenital diaphragmatic hernia—a narrative review – Holden – Translational Pediatrics

  https://tp.amegroups.org/article/view/115367/html

  The management of infants with CDH has improved because of specific advances including pressure-limited ventilation, extracorporeal life support (ECLS), and neonatal critical care expertise. […] While the overall survival rate among patients with CDH remains approximately 65-80%, depending upon numerous factors, select groups have suggested that further improvements in survival may be achievable through specific, evidence-based, protocol-driven adoption of specific management principles. […] For high-risk patients, their measured lung volumes were found to be 39% of the controls, and those who survived had much higher volumes compared to those who did not. […] With further understanding of the pathophysiology, new management strategies are based on reducing pre-capillary pulmonary vascular resistance and optimizing lung recruitment while avoiding overdistention and de-recruitment.

• #4 Congenital Diaphragmatic Hernia (CDH): Diagnosis and Treatment

  https://www.bannerhealth.com/services/maternity/programs-care/fetal-care-program/congenital-diaphragmatic-hernia

  Learning your baby has a rare congenital diaphragmatic hernia (CDH) feels anything but rare when its your own child. Our specialized fetal care team at Banner Health will make sure that you and your baby get the best possible care. […] Below, learn more about CDH, including causes, risk factors, signs and symptoms, treatment and long-term care. […] Early diagnosis during pregnancy (prenatal) is very important. It allows your baby to have careful tests inside the womb and gives your care team including neonatologists (doctors who specialize in infant care), pediatric surgeons, cardiologists and respiratory (breathing) specialists time to talk to you about treatment options and what to expect when your baby is born. […] Most babies with CDH are best treated after birth, but there are times when it may be possible important to treat the baby during pregnancy to help improve the babys lung development. In these cases, fetal tracheal occlusion (FETO) a procedure that blocks your babys trachea (windpipe) and helps with lung development may be done.

• #5 Management advances for congenital diaphragmatic hernia: integrating prenatal and postnatal perspectives – Baschat – Translational Pediatrics

  https://tp.amegroups.org/article/view/123659/html

  Optimal CDH care is initiated prenatally. As part of the prenatal severity assessment, parents have the opportunity to gather in-depth information on postnatal management strategies and expected outcomes from a range of pediatric experts that form the CDH management team. Prenatal surveillance of fetal growth and development is important. For patients that experience polyhydramnios and preterm labor, amnioreduction and medical management can prevent premature delivery. In preparation for delivery maternal administration of a course of betamethasone or dexamethasone to enhance fetal lung maturity should be considered in alignment with current society recommendations. Key elements of a CDH delivery are the swift establishment of a reliable airway to maximize the likelihood for control of ventilation pressures after birth, and gastric decompression to maximize lung excursion.

• #5 Congenital diaphragmatic hernia (CDH) – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/congenital-diaphragmatic-hernia/diagnosis-treatment/drc-20544259

  Treatment of congenital diaphragmatic hernia depends on when the condition is found and how serious it is. Your health care team helps you decide what’s best for you and your baby. […] An emerging treatment for severe CDH now being studied is called fetoscopic endoluminal tracheal occlusion (FETO). This surgery is done on your baby while you’re still pregnant. The goal is to help the baby’s lungs grow as much as possible before birth. […] FETO is done in two procedures: The first procedure happens early in the last few months (third trimester) of your pregnancy. Your surgeon makes a small incision in your abdomen and uterus. The surgeon inserts a special tube with a camera at the end, called a fetal endoscope, through your baby’s mouth and into the windpipe (trachea). A small balloon is placed in your baby’s trachea and inflated.

• #5 Congenital Diaphragmatic Hernia | Cardinal Glennon

  https://www.ssmhealth.com/cardinal-glennon/fetal-care-institute/fetal-conditions-we-treat/lungs/congenital-diaphragmatic-hernia/about

  CDH is typically detected through a routine ultrasound, which allows doctors to check the position of your baby’s lungs and heart. […] The Comprehensive CDH Care Team provides babies with CDH seamless care from the prenatal diagnosis, to neonatal surgical care, to ongoing care through the school-age years. […] Most babies with less severe CDH can be delivered vaginally at full-term, unless there are obstetric indications for cesarean delivery. […] In severe cases of CDH, we may recommend a special delivery procedure, called an EXIT procedure. […] The care of babies with CDH can be quite complex, with frequent blood tests, x-rays and machines that are helping to support your baby. […] When babies with CDH arrive in the NICU they begin the observation stage of their care until they are ready for hernia repair surgery.

• #5 Congenital diaphragmatic hernia (CDH) in neonates | Safer Care Victoria

  https://www.safercare.vic.gov.au/best-practice-improvement/clinical-guidance/neonatal/congenital-diaphragmatic-hernia-cdh-in-neonates

  The experience for babies managed at the Royal Children’s Hospital, Melbourne shows the survival for babies with isolated lesions to be approximately 80 per cent based on more than 240 infants. […] The aim is to achieve a normal vaginal birth following spontaneous onset of labour at term, but for pragmatic reasons induction of labour at 38-39 weeks may be offered. […] Resuscitation will be individualised according to the condition of the baby and the response to initial steps in resuscitation. However, most babies require intubation. […] Units that report very high survival rates concentrate on minimising lung injury, especially in the initial hours after birth and rarely exceed PIP of 25 cm H2O. […] A team of neonatologists, paediatric surgeons and paediatric intensivists is required. […] The principles of management and escalation of therapy include: use of muscle relaxants and sedatives, synchronised ventilation (SIMV or A/C) with tidal/minute volume monitoring, and surgery after ventilatory and circulatory support weaned to satisfactory levels.

• #5 Recent advances in the treatment of complex congenital diaphragmatic hernia—a narrative review – Holden – Translational Pediatrics

  https://tp.amegroups.org/article/view/115367/html

  The use of pulmonary vasodilator therapies like Sildenafil, Bosentan, Epoprostenol, prostaglandin E1 (PGE1), and milrinone have aided in the reduction of the right ventricular (RV) afterload while maintaining systemic blood flow. […] The first is the timing for umbilical cord clamping. The current practice of umbilical cord clamping before lung aeration and perinatal stabilization may contribute to worsening pulmonary hypertension. […] The use of PGE1 has also altered the management of pulmonary hypertension in CDH infants. […] Antenatal interventions like FETO have evolved to become a promising adjunct to the treatment of CDH. […] The FETO procedure occludes the trachea and prevents the regression of pulmonary fluid forcing pulmonary tissue and pulmonary vasculature into a hyperplastic state, ultimately causing growth and expansion to the alveoli and vasculature. […] These studies are just a start to how targeted therapy may improve the outcomes in high-risk CDH and offer a window for translationally relevant therapies to impact clinical interventions.

• #5 Diaphragmatic Hernias Treatment & Management: Approach Considerations, Medical Therapy for Congenital Diaphragmatic Hernia, Surgical Therapy for Congenital Diaphragmatic Hernia

  https://emedicine.medscape.com/article/934824-treatment

  For neonates who do require ECMO, early repair ( 48 hr post cannulation) has also been associated with better outcomes. […] Thus, if an infant can be stabilized without ECMO, and hemodynamics and gas exchange are stable, then repair is likely to be safe even if pulmonary hypertension has not resolved. If the patient requires ECMO therapy, early repair is recommended and is associated with improved outcomes. […] Although repair of the diaphragm defect is unlikely to improve pulmonary mechanics and pulmonary hypertension, CDH repair allows for initiation of enteral feeding and removal of central venous catheters and respiratory support. […] Delivery room management begins with intubation as soon as possible after the first breath to prevent air from entering the stomach and bowel during the infant’s respiratory efforts.

• #5 Surgical treatment of congenital diaphragmatic hernia in a single institution | Journal of Cardiothoracic Surgery | Full Text

  https://cardiothoracicsurgery.biomedcentral.com/articles/10.1186/s13019-022-02098-w

  This study aimed to evaluate the effectiveness of video-assisted thoracic surgery for the treatment of congenital diaphragmatic hernia (CDH) in a larger series compared with conventional open surgery. Additionally, we summarized the experience of thoracoscopic surgery in the treatment of CDH in infants. […] Thoracoscopic surgery and open surgery can effectively treat CDH. Compared with conventional open surgery, thoracoscopy has the advantages of shorter operation time, less trauma, faster recovery and fewer complications. We believe that thoracoscopic surgery for type A/B diaphragmatic defect has certain advantages, but there is a risk of recurrence.

• #5 Congenital Diaphragmatic Hernia | Children’s Wisconsin

  https://childrenswi.org/medical-care/fetal-concerns-center/conditions/infant-complications/congenital-diaphragmatic-hernia

  We also will place an arterial line called an umbilical artery catheter (UAC) in one of the arteries of the umbilical cord. We use this line to give IV fluid, remove blood for testing and monitor blood pressure. […] Some medications your baby may need before surgery include: Narcotics to keep your baby free from pain, Paralytics to keep your baby from moving, Blood pressure medication to maintain an adequate blood pressure or decrease abnormally high blood pressure in the heart and lungs. […] After surgery your baby will need continued assistance to breathe effectively. He or she will need frequent lab work to monitor oxygenation, electrolytes and blood counts. […] After surgery your baby may need a variety of medications including: Antibiotics to fight infection, Pain medication to control pain after surgery, Blood pressure medication to stabilize and maintain an adequate blood pressure, Sedation to keep your baby calm, Paralytics to keep your baby from moving.

• #5 Congenital Diaphragmatic Hernia Program | Columbia Surgery

  https://columbiasurgery.org/congenital-diaphragmatic-hernia

  Congenital diaphragmatic hernia (CDH) is a complex condition that requires specialized, multidisciplinary care from an experienced team. […] CDH is a serious, life-threatening condition that requires careful monitoring and surgical correction. […] The latest surgical options for hernia repair after birth, including minimally invasive techniques such as video assisted thoracoscopic surgery (VATS) […] CDH treatments may be an option before your baby is born. […] Babies born with CDH require immediate intensive care, and delivery may require specialized procedures like EXIT-to-ECMO. […] CDH is treated with surgical repair to close the opening in the diaphragm. […] Your child will receive a full cardiac exam and tests to determine their heart’s health, along with follow-up care when needed. […] Our experts will closely monitor your child’s GI system throughout childhood. […] As part of their follow-up care, a pulmonologist will regularly check your child’s lung health and function.

• #5 Management advances for congenital diaphragmatic hernia: integrating prenatal and postnatal perspectives – Baschat – Translational Pediatrics

  https://tp.amegroups.org/article/view/123659/html

  Although emergent repair of the CDH defect at birth was initially advocated to reduce mediastinal mass effect, this practice has been abandoned to allow for physiologic stability under medical management during the initial 24-48 hours of life. After surgical repair of the diaphragmatic defect, care focuses on weaning off cardiorespiratory support and optimizing nutrition. The transition to non-invasive modes of ventilation (such as continuous positive airway pressure and high-flow oxygen) is often required. The prevalence of significant malnutrition at discharge has been estimated to be 26%. More than 30% of infants are discharged on supplemental tube feeds, and over 10% received surgical feeding tube procedures (e.g., gastrostomy tubes) to ensure caloric needs owing to poor oral feeding.

• #5 Congenital Diaphragmatic Hernia Clinic | Phoenix Children’s Hospital

  https://phoenixchildrens.org/specialties-conditions/congenital-diaphragmatic-hernia-clinic

  Children with CDH come to the NICU right after they are born. The Phoenix Childrens Level IV NICU offers the highest level of care for newborns with health problems. Our expert team of neonatologists, pediatric specialists and dedicated NICU nurses all have extensive experience in managing the most critically ill newborns. […] Our surgical team is highly skilled and experienced in procedures to repair CDH. They will discuss with you the different surgical approaches, including minimally invasive techniques. Some children need more than one surgery to reach their best recovery from CDH. […] The specialists in our pulmonology team are experts at diagnosing and treating a wide range of lung issues that can affect children with CDH. […] Phoenix Childrens has a strong team of developmental pediatric therapists who can assess your child and provide targeted therapy to help with their development. This may include physical therapy, occupational therapy and feeding therapy.

• #5 Recent advances in the treatment of complex congenital diaphragmatic hernia—a narrative review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10416132/

  Congenital diaphragmatic hernia (CDH) is an anomaly of the cardiopulmonary system maturation process that results from both a global embryopathy and concomitant mechanical compression of the cardiopulmonary system from the abdominal contents during fetal maturation. […] Advances at the basic, translational, and clinical research levels are leading to novel therapies and management strategies for complex, high-risk CDH. […] The management of infants with CDH has improved because of specific advances including pressure-limited ventilation, extracorporeal life support (ECLS), and neonatal critical care expertise. […] While the overall survival rate among patients with CDH remains approximately 65-80%, depending upon numerous factors, select groups have suggested that further improvements in survival may be achievable through specific, evidence-based, protocol-driven adoption of specific management principles.

• #5 Recent advances in the treatment of complex congenital diaphragmatic hernia—a narrative review – Holden – Translational Pediatrics

  https://tp.amegroups.org/article/view/115367/html

  The management of infants with CDH has improved because of specific advances including pressure-limited ventilation, extracorporeal life support (ECLS), and neonatal critical care expertise. […] While the overall survival rate among patients with CDH remains approximately 65-80%, depending upon numerous factors, select groups have suggested that further improvements in survival may be achievable through specific, evidence-based, protocol-driven adoption of specific management principles. […] For high-risk patients, their measured lung volumes were found to be 39% of the controls, and those who survived had much higher volumes compared to those who did not. […] With further understanding of the pathophysiology, new management strategies are based on reducing pre-capillary pulmonary vascular resistance and optimizing lung recruitment while avoiding overdistention and de-recruitment.

• #5 Center for Congenital Diaphragmatic Hernia | UPMC Children’s

  https://www.chp.edu/our-services/surgery-pediatric/pediatric-surgery-services-we-offer/congenital-diaphragmatic-hernia

  Congenital diaphragmatic hernia (CDH) is a serious and complex birth defect. […] The Center for Congenital Diaphragmatic Hernia at UPMC Children’s Hospital of Pittsburgh provides advanced care for this life-threatening condition. […] Learn more about: Delivery and postnatal treatment. […] Surgery to repair the CDH usually happens within a few days to a week after birth. […] Newborns with severe breathing problems receive extracorporeal membrane oxygenation (ECMO) support. […] Our skilled pediatric surgeons will repair the defect in the diaphragm. […] More than half of all surgical repairs done by the Center are minimally invasive. […] After surgery, your baby will need continued NICU care. […] The best outcomes happen when newborns and children receive comprehensive, standardized, multidisciplinary care. […] UPMC Children’s is designated as a Platinum Level ELSO Center of Excellence.

• #6 Congenital Diaphragmatic Hernia (CDH) Prenatal Treatment | Memorial Hermann

  https://memorialhermann.org/services/treatments/congenital-diaphragmatic-hernia-prenatal-treatment

  Treatment for babies diagnosed with CDH has traditionally focused on care after delivery. […] For the most severe cases of CDH, The Fetal Center offers a fetal surgery procedure as a treatment option before birth. […] The Fetal Center and its affiliated physicians have been granted FDA and institutional approval to offer fetoscopic endoluminal tracheal occlusion (FETO) to treat babies diagnosed with severe CDH before birth through the Center’s participation in the Tracheal Occlusion To Accelerate Lung Growth (TOTAL) Trial. […] FETO intervention, a minimally invasive fetoscopic procedure performed during pregnancy, involves placing a balloon in the baby’s airway, causing a backup of fluid produced by the lungs. […] As the fluid builds, lung growth and development is promoted. […] For patients with congenital diagrammatic hernia (CDH) the level of care provided at the time of delivery can be critical to patients’ long-term health.

• #6 Congenital Diaphragmatic Hernia | Children’s Wisconsin

  https://childrenswi.org/medical-care/fetal-concerns-center/conditions/infant-complications/congenital-diaphragmatic-hernia

  At birth, most babies with CDH will need help to breathe. We will pass a tube into your baby’s airway to help with breathing. This tube passes through the vocal cords, so while it is in place, your baby will not be able to make sounds. […] We will pass another tube through your baby’s mouth and into the stomach. This is to keep the stomach decompressed, or small in size, so it does not press more on the lungs. […] Once your baby is delivered, we will quickly assess him or her. If at all possible, we will allow you and your partner to see and hold your baby. When necessary, we will transfer your baby to the NICU for further treatment. […] Typically the umbilical cord has two arteries and a vein. We will place a special tube called an umbilical venous catheter (UVC) in the vein in your baby’s umbilical cord so we can give nourishment (vitamins, minerals, calories, fat) and medication for a prolonged period of time.

• #6 Congenital Diaphragmatic Hernia | Children’s Wisconsin

  https://childrenswi.org/medical-care/fetal-concerns-center/conditions/infant-complications/congenital-diaphragmatic-hernia

  We also will place an arterial line called an umbilical artery catheter (UAC) in one of the arteries of the umbilical cord. We use this line to give IV fluid, remove blood for testing and monitor blood pressure. […] Some medications your baby may need before surgery include: Narcotics to keep your baby free from pain, Paralytics to keep your baby from moving, Blood pressure medication to maintain an adequate blood pressure or decrease abnormally high blood pressure in the heart and lungs. […] After surgery your baby will need continued assistance to breathe effectively. He or she will need frequent lab work to monitor oxygenation, electrolytes and blood counts. […] After surgery your baby may need a variety of medications including: Antibiotics to fight infection, Pain medication to control pain after surgery, Blood pressure medication to stabilize and maintain an adequate blood pressure, Sedation to keep your baby calm, Paralytics to keep your baby from moving.

• #6 Recent advances in the treatment of complex congenital diaphragmatic hernia—a narrative review – Holden – Translational Pediatrics

  https://tp.amegroups.org/article/view/115367/html

  The use of pulmonary vasodilator therapies like Sildenafil, Bosentan, Epoprostenol, prostaglandin E1 (PGE1), and milrinone have aided in the reduction of the right ventricular (RV) afterload while maintaining systemic blood flow. […] The first is the timing for umbilical cord clamping. The current practice of umbilical cord clamping before lung aeration and perinatal stabilization may contribute to worsening pulmonary hypertension. […] The use of PGE1 has also altered the management of pulmonary hypertension in CDH infants. […] Antenatal interventions like FETO have evolved to become a promising adjunct to the treatment of CDH. […] The FETO procedure occludes the trachea and prevents the regression of pulmonary fluid forcing pulmonary tissue and pulmonary vasculature into a hyperplastic state, ultimately causing growth and expansion to the alveoli and vasculature. […] These studies are just a start to how targeted therapy may improve the outcomes in high-risk CDH and offer a window for translationally relevant therapies to impact clinical interventions.

• #6 Congenital diaphragmatic hernia repair: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/002936.htm

  In either type of operation, the surgeon repairs the hole in the diaphragm. If the hole is small, it may be repaired with stitches. Otherwise, an artificial patch is used to cover the hole. […] Surgery to repair CDH must be done as early as possible after the baby is born. Even after surgery, some babies’ lungs are not able to function on their own because they are so underdeveloped. […] Your baby will be on a breathing machine after the surgery and will stay in the hospital for several weeks. Once taken off the breathing machine, your baby may still need oxygen and medicines for a while. […] The outcome of this surgery depends on how well your baby’s lungs have developed. Some babies have other medical problems, especially with the heart, brain, muscles, and joints, which often affect how well the baby does.

• #6 Congenital Diaphragmatic Hernia (CDH): Diagnosis and Treatment

  https://www.bannerhealth.com/services/maternity/programs-care/fetal-care-program/congenital-diaphragmatic-hernia

  Treatment plans may need to be modified if there are associated heart or other organ defects or genetic disorders. […] After surgery, your baby will need to remain in the NICU for ongoing care and monitoring. Your baby may need breathing support for a while as their lungs continue to develop. Depending on your babys condition, they may still need oxygen and special medicines to help with breathing after they leave the hospital. […] Your babys care team will be available to support you and your baby during this time. […] In addition to respiratory (breathing) support and surgery, you may also need to learn about other special needs (such as needing a feeding tube for a little while) and how CDH can affect your babys development. […] After your baby leaves the hospital, regular follow-up care is very important. At these visits, your babys care team will check your babys breathing, growth and development. These visits also make sure any new problems are dealt with as soon as possible, which helps keep your babys health on the right track.

• #6 Congenital Diaphragmatic Hernia | Conditions | UCSF Benioff Children’s Hospitals

  https://www.ucsfbenioffchildrens.org/conditions/congenital-diaphragmatic-hernia

  There is a wide range of severity and outcomes for CDH. In the best cases, some infants do very well with routine neonatal care and surgical treatment after birth. […] Even when the CDH is severe, however, more than 70 percent of affected babies can be saved with intensive support. […] Babies with severe CDH need very skilled intensive care: high-frequency oscillatory ventilation, inhaled nitric oxide and, in some cases, extracorporeal membrane oxygenation (ECMO). […] The surgery to repair CDH after birth is usually performed after the baby has stabilized in the first week of life. […] If the opening in the diaphragm is small and there is enough diaphragmatic muscle, the hole can be sewn closed. This is called a primary repair. […] In select circumstances, infants may be a candidate for a minimally invasive thoracoscopic repair. […] We recommend seeing your child’s pediatrician within one week of leaving the hospital. […] Some children will need another operation or operations later on, to repair a recurrence of the CDH.

• #6 Congenital Diaphragmatic Hernia (CDH): Symptoms, Diagnosis & Treatment | Nationwide Children’s Hospital

  https://www.nationwidechildrens.org/conditions/congenital-diaphragmatic-hernia

  Other treatments your baby will most likely need after surgery are: Antibiotic medicine to prevent infection, Fluids and nutrients through the PICC, Oxygen. Some babies need to go home with oxygen, Medicines to support blood pressure in the body and lower blood pressure in the lungs, Pain medicines as needed, A chest tube to help drain fluid from the incision. […] Babies with CDH are at risk for ongoing problems with the lungs, including asthma and respiratory infections. They are also at risk for ongoing problems with feeding, gastrointestinal reflux, and developmental delays. These risks are higher in babies that need ECMO. Physical and occupation therapy and early intervention may be needed to help your child.

• #6 Management of Congenital Diaphragmatic Hernia (CDH): Role of Molecular Genetics

  https://www.mdpi.com/1422-0067/22/12/6353

  This review of the literature provides an overview of current knowledge of normal diaphragm embryogenesis and a summary of genetic mutations as well as related pathways and cellular mechanisms involved in CDH whose knowledge is essential to the development of new therapeutic strategies and evidence-based genetic counselling to parents. […] The prognosis of isolated CDH is better than CDH associated with multiple abnormalities; a higher survival rate has also been demonstrated for the former. […] Prenatal diagnosis of CDH is possible as early as 12 weeks of gestation during first trimester ultrasound screen; CDH ultrasound detection is successful in 50% of cases at a mean gestational age of 24 weeks. […] The presence of associated abnormalities, particularly heart disease, extent of pulmonary hypoplasia, and liver position (intra-abdominal or intrathoracic) are the main determinants of CDH outcomes.

• #6 Congenital Diaphragmatic Hernia Program – NYC | ColumbiaDoctors Children’s Health

  https://www.columbiadoctors.org/childrens-health/pediatric-specialties/digestive-liver-disorders/our-services/congenital-diaphragmatic-hernia-program

  Columbias Congenital Diaphragmatic Hernia Program, located in NewYork-Presbyterian Morgan Stanley Children’s Hospital, offers long-term, multidisciplinary care for children born with congenital diaphragmatic hernia (CDH), a life-threatening condition. […] CDH requires multidisciplinary care. The Congenital Diaphragmatic Hernia Program brings together the vast expertise of Columbia’s pediatric specialists, including a pediatric surgeon, neonatologist, cardiologist with special expertise in pulmonary hypertension, pulmonologist, gastroenterologist, orthopedist, developmental pediatrician, and psychologist. […] Newborns with CDH have underdeveloped lungs and need immediate breathing support with a ventilator. NewYork-Presbyterian Morgan Stanley Children’s Hospital is a center of excellence for extracorporeal membrane oxygenation (ECMO), a mechanical life support system that completely takes over your baby’s breathing. ECMO is a life-saving support for some infants with CDH who need surgery before they can breathe independently.

• #7 Congenital diaphragmatic hernia (CDH) – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/congenital-diaphragmatic-hernia/diagnosis-treatment/drc-20544259

  After about 4 to 6 weeks, you have a second procedure. The balloon is removed so that your baby is ready to take air into the lungs after birth. […] A special delivery method may be used if labor starts before the balloon has been removed and removal of the balloon with an endoscope is not possible. This method is called an ex utero intrapartum treatment (EXIT) procedure. The delivery is done by C-section with placental support. This means that your baby continues to get oxygen through the placenta before the umbilical cord is cut. Placental support continues until the balloon is out and a breathing tube is in place, allowing a machine to take over breathing. […] FETO may not be the right choice for everyone. And there’s no guarantee about the results of surgery. Your health care team evaluates you and your baby to see whether you may be candidates for this surgery. Talk to your team about the benefits and possible complications for you and your baby.

• #7 Congenital Diaphragmatic Hernia: Symptoms and Treatment

  https://patient.info/doctor/congenital-diaphragmatic-hernia

  Congenital diaphragmatic hernia treatment and management […] Immediate care […] Children born without a prior diagnosis of congenital diaphragmatic hernia, present a paediatric emergency and the initial management must be aimed at reducing the pressure in the chest and increasing oxygenation. If bowel sounds are heard in the chest of a neonate who has respiratory distress, the child should be resuscitated in a 'head up’, rather than the more usual 'head down’, position. […] Infants with CDH require intensive cardiopulmonary support after birth, including immediate endotracheal intubation and gentle mechanical ventilation, as well as careful fluid and inotropic support. Avoid bag-and-mask ventilation in the delivery room because the stomach and intestines become distended with air and further impair lung function.

• #7 Congenital Diaphragmatic Hernia (CDH): Symptoms, Diagnosis & Treatment | Nationwide Children’s Hospital

  https://www.nationwidechildrens.org/conditions/congenital-diaphragmatic-hernia

  Other treatments your baby will most likely need after surgery are: Antibiotic medicine to prevent infection, Fluids and nutrients through the PICC, Oxygen. Some babies need to go home with oxygen, Medicines to support blood pressure in the body and lower blood pressure in the lungs, Pain medicines as needed, A chest tube to help drain fluid from the incision. […] Babies with CDH are at risk for ongoing problems with the lungs, including asthma and respiratory infections. They are also at risk for ongoing problems with feeding, gastrointestinal reflux, and developmental delays. These risks are higher in babies that need ECMO. Physical and occupation therapy and early intervention may be needed to help your child.

• #7 Recent advances in the treatment of complex congenital diaphragmatic hernia—a narrative review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10416132/

  The development of risk-stratification processes, best practices or guidelines of management, and novel therapies is critical to optimize the care of these infants. […] The use of pulmonary vasodilator therapies like Sildenafil, Bosentan, Epoprostenol, prostaglandin E1 (PGE1), and milrinone have aided in the reduction of the right ventricular (RV) afterload while maintaining systemic blood flow. […] The first is the timing for umbilical cord clamping. […] The use of PGE1 has also altered the management of pulmonary hypertension in CDH infants. […] The FETO procedure occludes the trachea and prevents the regression of pulmonary fluid forcing pulmonary tissue and pulmonary vasculature into a hyperplastic state, ultimately causing growth and expansion to the alveoli and vasculature. […] These studies provide early evidence that ventricular function is a key determinant of disease severity and highlight that it is emerging as an important predictor of outcome but leave the field open to further investigation. […] In conclusion, neonates with high-risk CDH, including the severe patients on the isolated CDH spectrum, along with those who have a CDH plus an associated anomaly, require special consideration and benefit from nuanced, multidisciplinary management.

• #7 Congenital Diaphragmatic Hernia | Fetal Care Center | Connecticut Children’s

  https://www.connecticutchildrens.org/specialties-conditions/fetal-care-center/fetal-care-conditions/congenital-diaphragmatic-hernia

  In less severe cases of CDH, usually without liver herniation, there may be sufficient diaphragm to perform a primary repair of the defect by sewing diaphragm to diaphragm to close the defect. […] In more severe cases, with larger defects and more visceral herniation, particularly involving the liver, a patch will be required to close the defect. […] The most common material used to close diaphragmatic defects is Gore-Tex (polytetrafluoroethylene PTFE). […] In contrast, the use of the transverse abdominis muscle flap has a very low rate of recurrent herniation. […] Once the CDH has been repaired, the baby enters a more stable phase of care, and the focus shifts to optimizing nutrition and weaning medications no longer needed. […] In most instances, the severity of pulmonary hypertension CDH gradually improves as the baby’s condition becomes more stable and the lung is allowed to expand fully after repair of the CDH.

• #7 Congenital Diaphragmatic Hernia | Children’s Wisconsin

  https://childrenswi.org/medical-care/fetal-concerns-center/conditions/infant-complications/congenital-diaphragmatic-hernia

  Your baby may look puffy or swollen after surgery. He or she will not be able to eat until his or her condition has stabilized. But we will provide nourishment through the IV fluids. […] Because infants with this condition cannot eat for a prolonged period of time, we will supply special nourishment through a central line. Total parenteral nutrition is an IV solution that contains protein, fats, sugar, vitamins and minerals. This will supply your baby with all his/her nutritional requirements until he or she is able to take food by mouth. […] Most babies with a diaphragmatic hernia will need immediate interventions after delivery. If your baby has CDH, it’s best if he or she is born at a hospital that can care for you and your baby. This keeps the two of you together and avoids the trauma of having to transport your baby after birth.

• #7 Congenital Diaphragmatic Hernia Program | Columbia Surgery

  https://columbiasurgery.org/congenital-diaphragmatic-hernia

  Congenital diaphragmatic hernia (CDH) is a complex condition that requires specialized, multidisciplinary care from an experienced team. […] CDH is a serious, life-threatening condition that requires careful monitoring and surgical correction. […] The latest surgical options for hernia repair after birth, including minimally invasive techniques such as video assisted thoracoscopic surgery (VATS) […] CDH treatments may be an option before your baby is born. […] Babies born with CDH require immediate intensive care, and delivery may require specialized procedures like EXIT-to-ECMO. […] CDH is treated with surgical repair to close the opening in the diaphragm. […] Your child will receive a full cardiac exam and tests to determine their heart’s health, along with follow-up care when needed. […] Our experts will closely monitor your child’s GI system throughout childhood. […] As part of their follow-up care, a pulmonologist will regularly check your child’s lung health and function.

• #7 Congenital diaphragmatic hernia (CDH) – CON-20472981-Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/congenital-diaphragmatic-hernia/symptoms-causes/syc-20544249

  Treatment of CDH depends on when the condition is found, how serious it is and whether there are problems with the heart. […] CDH may be found during a routine fetal ultrasound. Your health care provider can discuss treatment options with you. […] In some cases, CDH can be linked to a genetic disorder or random gene changes called mutations. In these cases, the baby may have more issues at birth, such as problems with the heart, eyes, arms and legs, or stomach and intestines.

• #7 Recent advances in the treatment of complex congenital diaphragmatic hernia—a narrative review – Holden – Translational Pediatrics

  https://tp.amegroups.org/article/view/115367/html

  The use of pulmonary vasodilator therapies like Sildenafil, Bosentan, Epoprostenol, prostaglandin E1 (PGE1), and milrinone have aided in the reduction of the right ventricular (RV) afterload while maintaining systemic blood flow. […] The first is the timing for umbilical cord clamping. The current practice of umbilical cord clamping before lung aeration and perinatal stabilization may contribute to worsening pulmonary hypertension. […] The use of PGE1 has also altered the management of pulmonary hypertension in CDH infants. […] Antenatal interventions like FETO have evolved to become a promising adjunct to the treatment of CDH. […] The FETO procedure occludes the trachea and prevents the regression of pulmonary fluid forcing pulmonary tissue and pulmonary vasculature into a hyperplastic state, ultimately causing growth and expansion to the alveoli and vasculature. […] These studies are just a start to how targeted therapy may improve the outcomes in high-risk CDH and offer a window for translationally relevant therapies to impact clinical interventions.

• #7 Congenital Diaphragmatic Hernia Clinic | Phoenix Children’s Hospital

  https://phoenixchildrens.org/specialties-conditions/congenital-diaphragmatic-hernia-clinic

  Children with CDH come to the NICU right after they are born. The Phoenix Childrens Level IV NICU offers the highest level of care for newborns with health problems. Our expert team of neonatologists, pediatric specialists and dedicated NICU nurses all have extensive experience in managing the most critically ill newborns. […] Our surgical team is highly skilled and experienced in procedures to repair CDH. They will discuss with you the different surgical approaches, including minimally invasive techniques. Some children need more than one surgery to reach their best recovery from CDH. […] The specialists in our pulmonology team are experts at diagnosing and treating a wide range of lung issues that can affect children with CDH. […] Phoenix Childrens has a strong team of developmental pediatric therapists who can assess your child and provide targeted therapy to help with their development. This may include physical therapy, occupational therapy and feeding therapy.

• #8 Congenital diaphragmatic hernia (CDH) – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/congenital-diaphragmatic-hernia/diagnosis-treatment/drc-20544259

  After about 4 to 6 weeks, you have a second procedure. The balloon is removed so that your baby is ready to take air into the lungs after birth. […] A special delivery method may be used if labor starts before the balloon has been removed and removal of the balloon with an endoscope is not possible. This method is called an ex utero intrapartum treatment (EXIT) procedure. The delivery is done by C-section with placental support. This means that your baby continues to get oxygen through the placenta before the umbilical cord is cut. Placental support continues until the balloon is out and a breathing tube is in place, allowing a machine to take over breathing. […] FETO may not be the right choice for everyone. And there’s no guarantee about the results of surgery. Your health care team evaluates you and your baby to see whether you may be candidates for this surgery. Talk to your team about the benefits and possible complications for you and your baby.

• #8 Congenital Diaphragmatic Hernia | Children’s Wisconsin

  https://childrenswi.org/medical-care/fetal-concerns-center/conditions/infant-complications/congenital-diaphragmatic-hernia

  At birth, most babies with CDH will need help to breathe. We will pass a tube into your baby’s airway to help with breathing. This tube passes through the vocal cords, so while it is in place, your baby will not be able to make sounds. […] We will pass another tube through your baby’s mouth and into the stomach. This is to keep the stomach decompressed, or small in size, so it does not press more on the lungs. […] Once your baby is delivered, we will quickly assess him or her. If at all possible, we will allow you and your partner to see and hold your baby. When necessary, we will transfer your baby to the NICU for further treatment. […] Typically the umbilical cord has two arteries and a vein. We will place a special tube called an umbilical venous catheter (UVC) in the vein in your baby’s umbilical cord so we can give nourishment (vitamins, minerals, calories, fat) and medication for a prolonged period of time.

• #8 Congenital Diaphragmatic Hernia | Children’s Wisconsin

  https://childrenswi.org/medical-care/fetal-concerns-center/conditions/infant-complications/congenital-diaphragmatic-hernia

  We also will place an arterial line called an umbilical artery catheter (UAC) in one of the arteries of the umbilical cord. We use this line to give IV fluid, remove blood for testing and monitor blood pressure. […] Some medications your baby may need before surgery include: Narcotics to keep your baby free from pain, Paralytics to keep your baby from moving, Blood pressure medication to maintain an adequate blood pressure or decrease abnormally high blood pressure in the heart and lungs. […] After surgery your baby will need continued assistance to breathe effectively. He or she will need frequent lab work to monitor oxygenation, electrolytes and blood counts. […] After surgery your baby may need a variety of medications including: Antibiotics to fight infection, Pain medication to control pain after surgery, Blood pressure medication to stabilize and maintain an adequate blood pressure, Sedation to keep your baby calm, Paralytics to keep your baby from moving.

• #8 Recent advances in the treatment of complex congenital diaphragmatic hernia—a narrative review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10416132/

  The development of risk-stratification processes, best practices or guidelines of management, and novel therapies is critical to optimize the care of these infants. […] The use of pulmonary vasodilator therapies like Sildenafil, Bosentan, Epoprostenol, prostaglandin E1 (PGE1), and milrinone have aided in the reduction of the right ventricular (RV) afterload while maintaining systemic blood flow. […] The first is the timing for umbilical cord clamping. […] The use of PGE1 has also altered the management of pulmonary hypertension in CDH infants. […] The FETO procedure occludes the trachea and prevents the regression of pulmonary fluid forcing pulmonary tissue and pulmonary vasculature into a hyperplastic state, ultimately causing growth and expansion to the alveoli and vasculature. […] These studies provide early evidence that ventricular function is a key determinant of disease severity and highlight that it is emerging as an important predictor of outcome but leave the field open to further investigation. […] In conclusion, neonates with high-risk CDH, including the severe patients on the isolated CDH spectrum, along with those who have a CDH plus an associated anomaly, require special consideration and benefit from nuanced, multidisciplinary management.

• #8 Congenital Diaphragmatic Hernia | Fetal Care Center | Connecticut Children’s

  https://www.connecticutchildrens.org/specialties-conditions/fetal-care-center/fetal-care-conditions/congenital-diaphragmatic-hernia

  In less severe cases of CDH, usually without liver herniation, there may be sufficient diaphragm to perform a primary repair of the defect by sewing diaphragm to diaphragm to close the defect. […] In more severe cases, with larger defects and more visceral herniation, particularly involving the liver, a patch will be required to close the defect. […] The most common material used to close diaphragmatic defects is Gore-Tex (polytetrafluoroethylene PTFE). […] In contrast, the use of the transverse abdominis muscle flap has a very low rate of recurrent herniation. […] Once the CDH has been repaired, the baby enters a more stable phase of care, and the focus shifts to optimizing nutrition and weaning medications no longer needed. […] In most instances, the severity of pulmonary hypertension CDH gradually improves as the baby’s condition becomes more stable and the lung is allowed to expand fully after repair of the CDH.

• #8 Congenital Diaphragmatic Hernia (CDH): Symptoms, Diagnosis & Treatment | Nationwide Children’s Hospital

  https://www.nationwidechildrens.org/conditions/congenital-diaphragmatic-hernia

  Other treatments your baby will most likely need after surgery are: Antibiotic medicine to prevent infection, Fluids and nutrients through the PICC, Oxygen. Some babies need to go home with oxygen, Medicines to support blood pressure in the body and lower blood pressure in the lungs, Pain medicines as needed, A chest tube to help drain fluid from the incision. […] Babies with CDH are at risk for ongoing problems with the lungs, including asthma and respiratory infections. They are also at risk for ongoing problems with feeding, gastrointestinal reflux, and developmental delays. These risks are higher in babies that need ECMO. Physical and occupation therapy and early intervention may be needed to help your child.

• #8 Congenital Diaphragmatic Hernia Program | Columbia Surgery

  https://columbiasurgery.org/congenital-diaphragmatic-hernia

  Congenital diaphragmatic hernia (CDH) is a complex condition that requires specialized, multidisciplinary care from an experienced team. […] CDH is a serious, life-threatening condition that requires careful monitoring and surgical correction. […] The latest surgical options for hernia repair after birth, including minimally invasive techniques such as video assisted thoracoscopic surgery (VATS) […] CDH treatments may be an option before your baby is born. […] Babies born with CDH require immediate intensive care, and delivery may require specialized procedures like EXIT-to-ECMO. […] CDH is treated with surgical repair to close the opening in the diaphragm. […] Your child will receive a full cardiac exam and tests to determine their heart’s health, along with follow-up care when needed. […] Our experts will closely monitor your child’s GI system throughout childhood. […] As part of their follow-up care, a pulmonologist will regularly check your child’s lung health and function.

• #8 Congenital diaphragmatic hernia repair: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/002936.htm

  In either type of operation, the surgeon repairs the hole in the diaphragm. If the hole is small, it may be repaired with stitches. Otherwise, an artificial patch is used to cover the hole. […] Surgery to repair CDH must be done as early as possible after the baby is born. Even after surgery, some babies’ lungs are not able to function on their own because they are so underdeveloped. […] Your baby will be on a breathing machine after the surgery and will stay in the hospital for several weeks. Once taken off the breathing machine, your baby may still need oxygen and medicines for a while. […] The outcome of this surgery depends on how well your baby’s lungs have developed. Some babies have other medical problems, especially with the heart, brain, muscles, and joints, which often affect how well the baby does.

• #8 Congenital Diaphragmatic Hernia Repair – UF Health

  https://ufhealth.org/conditions-and-treatments/congenital-diaphragmatic-hernia-repair

  UF Health Shands Childrens Hospital is one of the few childrens hospitals in the country that has a whole program based on caring for patients with congenital diaphragmatic hernia. […] We have treated over 300 CDH infants, and for patients that dont have a second life-threatening birth defect in addition to their CDH, survival approaches 90% (99% for left CDH with liver in abdomen, 92% for right CDH, and 75% for left CDH liver in chest, overall 88%. Annals of Surgery 2013). […] Our multidisciplinary team of specialists provides around-the-clock care for CDH babies, from birth to discharge, emphasizing lung protection, brain protection, and an individualized treatment strategy based on risk stratification. […] As part of an academic health system, we are actively involved in research about the treatment of CDH to increase survival rates and optimize outcomes.

• #8 Recent advances in the treatment of complex congenital diaphragmatic hernia—a narrative review – Holden – Translational Pediatrics

  https://tp.amegroups.org/article/view/115367/html

  The use of pulmonary vasodilator therapies like Sildenafil, Bosentan, Epoprostenol, prostaglandin E1 (PGE1), and milrinone have aided in the reduction of the right ventricular (RV) afterload while maintaining systemic blood flow. […] The first is the timing for umbilical cord clamping. The current practice of umbilical cord clamping before lung aeration and perinatal stabilization may contribute to worsening pulmonary hypertension. […] The use of PGE1 has also altered the management of pulmonary hypertension in CDH infants. […] Antenatal interventions like FETO have evolved to become a promising adjunct to the treatment of CDH. […] The FETO procedure occludes the trachea and prevents the regression of pulmonary fluid forcing pulmonary tissue and pulmonary vasculature into a hyperplastic state, ultimately causing growth and expansion to the alveoli and vasculature. […] These studies are just a start to how targeted therapy may improve the outcomes in high-risk CDH and offer a window for translationally relevant therapies to impact clinical interventions.

• #8 Congenital Diaphragmatic Hernia Program – NYC | ColumbiaDoctors Children’s Health

  https://www.columbiadoctors.org/childrens-health/pediatric-specialties/digestive-liver-disorders/our-services/congenital-diaphragmatic-hernia-program

  Columbias Congenital Diaphragmatic Hernia Program, located in NewYork-Presbyterian Morgan Stanley Children’s Hospital, offers long-term, multidisciplinary care for children born with congenital diaphragmatic hernia (CDH), a life-threatening condition. […] CDH requires multidisciplinary care. The Congenital Diaphragmatic Hernia Program brings together the vast expertise of Columbia’s pediatric specialists, including a pediatric surgeon, neonatologist, cardiologist with special expertise in pulmonary hypertension, pulmonologist, gastroenterologist, orthopedist, developmental pediatrician, and psychologist. […] Newborns with CDH have underdeveloped lungs and need immediate breathing support with a ventilator. NewYork-Presbyterian Morgan Stanley Children’s Hospital is a center of excellence for extracorporeal membrane oxygenation (ECMO), a mechanical life support system that completely takes over your baby’s breathing. ECMO is a life-saving support for some infants with CDH who need surgery before they can breathe independently.

• #9 Congenital Diaphragmatic Hernia | Causes, Diagnosis & Treatment

  https://www.cincinnatichildrens.org/health/c/diaphragmatic-hernias

  This birthing approach is called ex utero intrapartum treatment-to-extracorporeal membrane oxygenation, or EXIT-to-ECMO. Its a type of cesarean delivery (C-section) where the baby is removed from the womb and then immediately placed on a heart and lung bypass machine called an ECMO. […] When babies are born with CDH, a breathing tube is placed right away so that they can receive breathing support through a ventilator (breathing machine) right after birth. […] Most babies with CDH need surgery to repair the hole in their diaphragm. This surgery may take place days or weeks after birth, depending on the babys overall health. […] During the procedure, a surgeon moves the abdominal organs into their proper place. Then they permanently close the hole in the diaphragm. […] Some babies with severe CDH may remain on ECMO for several weeks after surgery. This gives their lungs a longer window in which to heal and recover. […] All babies who undergo CDH repair surgery can expect to stay in the NICU for recovery for at least 12 weeks.

• #9 Congenital Diaphragmatic Hernia: Symptoms and Treatment

  https://patient.info/doctor/congenital-diaphragmatic-hernia

  Passage of an orogastric tube will facilitate location of the stomach on X-ray, as well as permitting decompression of the stomach. […] Use of surfactant at an early stage may be beneficial. […] Blood gases should be monitored and an indwelling arterial catheter is advantageous. An indwelling venous catheter will enable administration of drugs (eg, inotropic agents and hypertonic solutions). […] Pulmonary hypertension, as assessed by echocardiography, may require the use of pulmonary vasodilators and other medical adjuncts (eg, prostaglandin E1, milrinone) or, in severe cases, extracorporeal life support, if available. […] Non-surgical management […] The aim is to optimise oxygenation while avoiding barotrauma. These infants are critically ill and will invariably need intensive care support.

• #9 Congenital Diaphragmatic Hernia | Children’s Wisconsin

  https://childrenswi.org/medical-care/fetal-concerns-center/conditions/infant-complications/congenital-diaphragmatic-hernia

  Your baby may look puffy or swollen after surgery. He or she will not be able to eat until his or her condition has stabilized. But we will provide nourishment through the IV fluids. […] Because infants with this condition cannot eat for a prolonged period of time, we will supply special nourishment through a central line. Total parenteral nutrition is an IV solution that contains protein, fats, sugar, vitamins and minerals. This will supply your baby with all his/her nutritional requirements until he or she is able to take food by mouth. […] Most babies with a diaphragmatic hernia will need immediate interventions after delivery. If your baby has CDH, it’s best if he or she is born at a hospital that can care for you and your baby. This keeps the two of you together and avoids the trauma of having to transport your baby after birth.

• #9 Recent advances in the treatment of complex congenital diaphragmatic hernia—a narrative review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10416132/

  The development of risk-stratification processes, best practices or guidelines of management, and novel therapies is critical to optimize the care of these infants. […] The use of pulmonary vasodilator therapies like Sildenafil, Bosentan, Epoprostenol, prostaglandin E1 (PGE1), and milrinone have aided in the reduction of the right ventricular (RV) afterload while maintaining systemic blood flow. […] The first is the timing for umbilical cord clamping. […] The use of PGE1 has also altered the management of pulmonary hypertension in CDH infants. […] The FETO procedure occludes the trachea and prevents the regression of pulmonary fluid forcing pulmonary tissue and pulmonary vasculature into a hyperplastic state, ultimately causing growth and expansion to the alveoli and vasculature. […] These studies provide early evidence that ventricular function is a key determinant of disease severity and highlight that it is emerging as an important predictor of outcome but leave the field open to further investigation. […] In conclusion, neonates with high-risk CDH, including the severe patients on the isolated CDH spectrum, along with those who have a CDH plus an associated anomaly, require special consideration and benefit from nuanced, multidisciplinary management.

• #9 Diaphragmatic Hernias Treatment & Management: Approach Considerations, Medical Therapy for Congenital Diaphragmatic Hernia, Surgical Therapy for Congenital Diaphragmatic Hernia

  https://emedicine.medscape.com/article/934824-treatment

  Surgical repair can often be safely delayed in stable patients, and the operation can be scheduled on a semielective basis. Urgent surgical repair is almost never necessary and may induce a pulmonary hypertension crisis. […] CDH is typically repaired either through an open abdominal incision or thoracoscopically. […] The use of chest tubes is controversial. […] Thoracoscopic repair of CDH offers several advantages (eg, improved visibility, reduced postoperative opioid use, and shorter ventilation duration), though outcomes may vary, depending on patient selection. […] Surgical repair with the patient on ECMO was initially associated with increases in mortality, surgical-site hemorrhage, and intracranial hemorrhage. […] The evolution of fetal intervention for CDH has been shaped by two developments: the advent of minimally invasive surgical techniques and insights from the study of congenital high airway obstruction syndrome (CHAOS), in which airway occlusion led to lung overexpansion.

• #9 Congenital Diaphragmatic Hernia (CDH) | Lurie Children’s

  https://www.luriechildrens.org/en/specialties-conditions/congenital-diaphragmatic-hernia/

  The first phase of the baby’s NICU care is the resuscitation and stabilization phase which begins at delivery and continues for approximately 3-5 days. […] The second phase of NICU care is the surgical phase which begins no earlier than 3 days after birth but may be delayed for several days if the baby remains unstable. […] The final phase of the NICU care for CDH babies is the feeding and growing phase. […] The vast majority of CDH babies survive and grow up to have normal, active and independent lives. […] Care by the multidisciplinary CDH team will continue after discharge from the NICU in partnership with the baby’s primary pediatrician to monitor and support the baby’s needs.

• #9 Congenital diaphragmatic hernia repair: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/002936.htm

  In either type of operation, the surgeon repairs the hole in the diaphragm. If the hole is small, it may be repaired with stitches. Otherwise, an artificial patch is used to cover the hole. […] Surgery to repair CDH must be done as early as possible after the baby is born. Even after surgery, some babies’ lungs are not able to function on their own because they are so underdeveloped. […] Your baby will be on a breathing machine after the surgery and will stay in the hospital for several weeks. Once taken off the breathing machine, your baby may still need oxygen and medicines for a while. […] The outcome of this surgery depends on how well your baby’s lungs have developed. Some babies have other medical problems, especially with the heart, brain, muscles, and joints, which often affect how well the baby does.

• #9 Congenital Diaphragmatic Hernia (CDH): Symptoms, Diagnosis & Treatment | Nationwide Children’s Hospital

  https://www.nationwidechildrens.org/conditions/congenital-diaphragmatic-hernia

  Other treatments your baby will most likely need after surgery are: Antibiotic medicine to prevent infection, Fluids and nutrients through the PICC, Oxygen. Some babies need to go home with oxygen, Medicines to support blood pressure in the body and lower blood pressure in the lungs, Pain medicines as needed, A chest tube to help drain fluid from the incision. […] Babies with CDH are at risk for ongoing problems with the lungs, including asthma and respiratory infections. They are also at risk for ongoing problems with feeding, gastrointestinal reflux, and developmental delays. These risks are higher in babies that need ECMO. Physical and occupation therapy and early intervention may be needed to help your child.

• #9 Management of Congenital Diaphragmatic Hernia (CDH): Role of Molecular Genetics

  https://www.mdpi.com/1422-0067/22/12/6353

  This review of the literature provides an overview of current knowledge of normal diaphragm embryogenesis and a summary of genetic mutations as well as related pathways and cellular mechanisms involved in CDH whose knowledge is essential to the development of new therapeutic strategies and evidence-based genetic counselling to parents. […] The prognosis of isolated CDH is better than CDH associated with multiple abnormalities; a higher survival rate has also been demonstrated for the former. […] Prenatal diagnosis of CDH is possible as early as 12 weeks of gestation during first trimester ultrasound screen; CDH ultrasound detection is successful in 50% of cases at a mean gestational age of 24 weeks. […] The presence of associated abnormalities, particularly heart disease, extent of pulmonary hypoplasia, and liver position (intra-abdominal or intrathoracic) are the main determinants of CDH outcomes.

• #9 Caring for Children With Congenital Diaphragmatic Hernia | Children’s Healthcare of Atlanta

  https://www.choa.org/research/congenital-diaphragmatic-hernia-care

  Congenital diaphragmatic hernia (CDH) is a birth defect in which the diaphragm does not develop completely, allowing abdominal organs to migrate into the chest and potentially restrict lung development. CDH occurs in 2.7 to 3.5 in 10,000 births and has a survival rate of about 70% with newer treatment modalities. Childrens Healthcare of Atlanta is well-equipped to treat these complex cases, with an in-house ECMO Center and surgeons at the forefront of treatment. […] The goal of this study is to investigate long-term outcomes, including QoL, for patients with CDH. […] At Childrens, CDH repairs are performed thoracoscopically, or in a minimally invasive way, whenever possible. […] What I think separates our practice from many others across the country is the fact that we all have this skill set, and regardless of which surgeon you end up with, youre likely to have a minimally invasive operation if its the right thing for your child.

• #9 CDH Center for Infants and Children | Rady Children’s Hospital

  https://www.rchsd.org/programs-services/comprehensive-congenital-diaphragmatic-hernia-center/

  The medical and surgical teams work closely to determine the optimal timing of the surgical repair for CDH patients. After your child recovers, CDH care will shift to include the developmental skills of your baby under the supervision of our physical therapists and occupational therapists. […] Most babies with CDH will need a breathing tube and may need help from a ventilator for many weeks. Your baby will be seen by a neonatologist and a pediatric surgeon. Consults to other specialties including genetics, cardiology, pulmonary hypertension, pulmonology, and gastroenterology will occur as needed. […] Once your baby is fit for surgery, our healthcare professionals will then repair the hole in the diaphragm and replace the intestines and other organs back in the abdomen. The timing of repair will be carefully decided based on your babys individual case.

• #10 Congenital Diaphragmatic Hernia: Symptoms and Treatment

  https://patient.info/doctor/congenital-diaphragmatic-hernia

  Congenital diaphragmatic hernia treatment and management […] Immediate care […] Children born without a prior diagnosis of congenital diaphragmatic hernia, present a paediatric emergency and the initial management must be aimed at reducing the pressure in the chest and increasing oxygenation. If bowel sounds are heard in the chest of a neonate who has respiratory distress, the child should be resuscitated in a 'head up’, rather than the more usual 'head down’, position. […] Infants with CDH require intensive cardiopulmonary support after birth, including immediate endotracheal intubation and gentle mechanical ventilation, as well as careful fluid and inotropic support. Avoid bag-and-mask ventilation in the delivery room because the stomach and intestines become distended with air and further impair lung function.

• #10 Surgical treatment of congenital diaphragmatic hernia in a single institution | Journal of Cardiothoracic Surgery | Full Text

  https://cardiothoracicsurgery.biomedcentral.com/articles/10.1186/s13019-022-02098-w

  This study aimed to evaluate the effectiveness of video-assisted thoracic surgery for the treatment of congenital diaphragmatic hernia (CDH) in a larger series compared with conventional open surgery. Additionally, we summarized the experience of thoracoscopic surgery in the treatment of CDH in infants. […] Thoracoscopic surgery and open surgery can effectively treat CDH. Compared with conventional open surgery, thoracoscopy has the advantages of shorter operation time, less trauma, faster recovery and fewer complications. We believe that thoracoscopic surgery for type A/B diaphragmatic defect has certain advantages, but there is a risk of recurrence.

• #10 Congenital Diaphragmatic Hernia Clinic | Phoenix Children’s Hospital

  https://phoenixchildrens.org/specialties-conditions/congenital-diaphragmatic-hernia-clinic

  Children with CDH come to the NICU right after they are born. The Phoenix Childrens Level IV NICU offers the highest level of care for newborns with health problems. Our expert team of neonatologists, pediatric specialists and dedicated NICU nurses all have extensive experience in managing the most critically ill newborns. […] Our surgical team is highly skilled and experienced in procedures to repair CDH. They will discuss with you the different surgical approaches, including minimally invasive techniques. Some children need more than one surgery to reach their best recovery from CDH. […] The specialists in our pulmonology team are experts at diagnosing and treating a wide range of lung issues that can affect children with CDH. […] Phoenix Childrens has a strong team of developmental pediatric therapists who can assess your child and provide targeted therapy to help with their development. This may include physical therapy, occupational therapy and feeding therapy.

• #10 Congenital Diaphragmatic Hernia – Seattle Children’s

  https://www.seattlechildrens.org/conditions/congenital-diaphragmatic-hernia/

  All babies with a CDH need surgery to gently move their abdominal organs down from their chest. The surgeon closes the hole in the diaphragm with stitches or a patch of synthetic material. […] After surgery, your child will continue to receive the highest level of care in our Level IV NICU. When your baby no longer needs a ventilator and is stable, they will move out of the NICU to a regular hospital room. […] Most children who receive follow-up CDH care at Seattle Children’s meet expected milestones for growth and development by the time they start school.

• #10 Golden hour management of infants with congenital diaphragmatic hernia: 15 year experience at a high-volume center | Journal of Perinatology

  https://www.nature.com/articles/s41372-025-02226-z

  To review the evolution of golden hour management and outcomes for infants with congenital diaphragmatic hernia (CDH). […] Management of infants with CDH continues to evolve with ongoing experience at our high-volume center. Despite increasing severity of illness, survival outcomes have improved over time. […] Effective delivery room (DR) resuscitation of infants with CDH is complex and requires critical interventions to occur simultaneously or in quick succession. Rapid intubation and early gentle ventilation optimize gas exchange and are associated with improved survival. […] Notable changes to golden hour management for infants with CDH included lower initial fraction of inspired oxygen, severity-specific DR algorithms including HFOV as the initial mode of ventilation in severe CDH, and reduction of empiric inhaled nitric oxide.

• #10 Congenital Diaphragmatic Hernia – Seattle Children’s

  https://www.seattlechildrens.org/conditions/congenital-diaphragmatic-hernia/

  A congenital diaphragmatic hernia (CDH) happens if the diaphragm does not form completely before birth. This leaves a hole between your baby’s belly (abdomen) and chest. Organs that should be in the belly go through the hole up into the chest, crowding the lungs. […] A CDH can be life-threatening. At Seattle Children’s, the average survival rate for babies with a CDH is 85-90% significantly higher than the national average. We believe every child with CDH can survive. […] If your child has a congenital diaphragmatic hernia (CDH), Seattle Children’s team has the medical and surgical expertise to help your child not only survive, but thrive from diagnosis through treatment and long-term follow-up care. […] At Seattle Children’s CDH Program, a coordinated team of surgeons, neonatologists, cardiologists, pulmonologists, pediatric intensivists and nutritionists will treat your child. The same team of pediatric surgeons and neonatologists will be involved in your baby’s care before their birth and throughout their hospital stay. This allows us to get to know your baby very well and give them the very best care.

• #11 Management of Congenital Diaphragmatic Hernia (CDH): Role of Molecular Genetics

  https://www.mdpi.com/1422-0067/22/12/6353

  Advances in genomics, coupled with functional studies in animal models, are increasingly identifying the causes of CDH in both familial and sporadic cases. […] A key challenge will be to understand which molecular pathways are most commonly disrupted and contribute to diaphragm and lung defects in CDH. […] The discovery of harmful de novo variants in the fetus could constitute an important tool for the medical team during pregnancy.

• #11 CDH Center for Infants and Children | Rady Children’s Hospital

  https://www.rchsd.org/programs-services/comprehensive-congenital-diaphragmatic-hernia-center/

  The medical and surgical teams work closely to determine the optimal timing of the surgical repair for CDH patients. After your child recovers, CDH care will shift to include the developmental skills of your baby under the supervision of our physical therapists and occupational therapists. […] Most babies with CDH will need a breathing tube and may need help from a ventilator for many weeks. Your baby will be seen by a neonatologist and a pediatric surgeon. Consults to other specialties including genetics, cardiology, pulmonary hypertension, pulmonology, and gastroenterology will occur as needed. […] Once your baby is fit for surgery, our healthcare professionals will then repair the hole in the diaphragm and replace the intestines and other organs back in the abdomen. The timing of repair will be carefully decided based on your babys individual case.

• #12 Center for Congenital Diaphragmatic Hernia | UPMC Children’s

  https://www.chp.edu/our-services/surgery-pediatric/pediatric-surgery-services-we-offer/congenital-diaphragmatic-hernia

  Congenital diaphragmatic hernia (CDH) is a serious and complex birth defect. […] The Center for Congenital Diaphragmatic Hernia at UPMC Children’s Hospital of Pittsburgh provides advanced care for this life-threatening condition. […] Learn more about: Delivery and postnatal treatment. […] Surgery to repair the CDH usually happens within a few days to a week after birth. […] Newborns with severe breathing problems receive extracorporeal membrane oxygenation (ECMO) support. […] Our skilled pediatric surgeons will repair the defect in the diaphragm. […] More than half of all surgical repairs done by the Center are minimally invasive. […] After surgery, your baby will need continued NICU care. […] The best outcomes happen when newborns and children receive comprehensive, standardized, multidisciplinary care. […] UPMC Children’s is designated as a Platinum Level ELSO Center of Excellence.

• #13 Diagnosis and management of congenital diaphragmatic hernia: a 2023 update from the Canadian Congenital Diaphragmatic Hernia Collaborative | ADC Fetal & Neonatal Edition

  https://fn.bmj.com/content/109/3/239

  Gastro-oesophageal reflux disease (GERD) is extremely prevalent with formal impedance testing demonstrating persistence of GERD in 60% of infants with CDH beyond 1year of age. […] This updated CPG provides an evidence-based and consensus-driven management framework that aims to improve outcomes and encourage synthesis of new knowledge through targeted research and quality improvement efforts.

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