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Congenital diaphragmatic hernia: review of the literature in reflection of unresolved dilemmas

  1. S Grisaru-Granovsky1,
  2. R Rabinowitz1,2,
  3. A Ioscovich3,
  4. D Elstein4,
  5. MS Schimmel5

Article first published online: 20 JUL 2009

DOI: 10.1111/j.1651-2227.2009.01436.x

Issue

Acta Paediatrica

Acta Paediatrica

Volume 98, Issue 12, pages 1874–1881, December 2009

Additional Information

How to Cite

Grisaru-Granovsky, S., Rabinowitz, R., Ioscovich, A., Elstein, D. and Schimmel, M. (2009), Congenital diaphragmatic hernia: review of the literature in reflection of unresolved dilemmas. Acta Paediatrica, 98: 1874–1881. doi: 10.1111/j.1651-2227.2009.01436.x

Author Information

  1. 1

    Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Jerusalem, Israel

  2. 2

    Division of Obstetric and Gynecological Imaging, Shaare Zedek Medical Center, Jerusalem, Israel

  3. 3

    Department of Anesthesia, Shaare Zedek Medical Center, Jerusalem, Israel

  4. 4

    Division of Gaucher Clinic, Shaare Zedek Medical Center, Jerusalem, Israel

  5. 5

    Department of Neonatology, Shaare Zedek Medical Center, Jerusalem, Israel

*D Elstein, Gaucher Clinic, Shaare Zedek Medical Center, One Bazak Road, Jerusalem 91031, Israel. Tel: +972-50-868-5943 | Fax: +972-2-651-7979 | Email: elstein@szmc.org.il

Publication History

  1. Issue published online: 2 NOV 2009
  2. Article first published online: 20 JUL 2009
  3. Received 12 January 2009; revised 5 April 2009; accepted 24 June 2009.

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Keywords:

  • Antenatal diagnosis;
  • Congenital diaphragmatic hernia;
  • Foetal surgery;
  • Hypoplastic lung

Abstract

Background:  Congenital diaphragmatic hernia (CDH) is a rare but clinically and scientifically challenging condition. The introduction of ultrasound has enabled early prenatal detection and consequently, hope of early therapeutic intervention.

Aim:  We undertook the task to review the recent developments in understanding the pathology of CDH as well as the history and current management strategies to aid perinatologists in consultations with parents of CDH-affected foetuses.

Study design:  A Medline search was undertaken of all reports and reviews published between 1980 and 2008 using MeSH search terms ‘diaphragmatic hernia’, ‘congenital’ and ‘newborn’.

Results:  The true incidence of CDH is still difficult to estimate because of the high incidence of hidden mortality of CDH. Complete case ascertainment also poses difficulties in assessment of the impact of new therapeutic modalities on overall survival. Recent improvements in prenatal detection are a milestone in affording time for re-assessments and parental counselling. The true benefit of antenatal therapy is circumscribed and should be offered only in selected cases of isolated severe CDH as defined by existing guidelines. Postnatal intensive respiratory supportive therapy and innovative surgical techniques within specialized tertiary centres has had a major impact on survival of babies with CDH.

Conclusion:  The high survival of ‘selected cases’ that are live births and benefit from optimal care will be difficult to improve by antenatal interventions. The multidisciplinary approach to basic research and randomized clinical trials will further define the best approach to the foetus and neonate with CDH.

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