Open AccessUpdate on Congenital Diaphragmatic Hernia
Author(s) -
Debnath Chatterjee,
Richard J. Ing,
Jason Gien
Publication year - 2019
Publication title -
anesthesia and analgesia/anesthesia and analgesia
Language(s) - Uncategorized
Resource type - Journals
SCImago Journal Rank - 1.404
H-Index - 201
eISSN - 1526-7598
pISSN - 0003-2999
DOI - 10.1213/ane.0000000000004324
Subject(s) - medicine , congenital diaphragmatic hernia , pulmonary hypoplasia , diaphragm (acoustics) , prenatal diagnosis , diaphragmatic breathing , hypoplasia , pulmonary hypertension , hernia , intensive care medicine , fetus , diaphragmatic hernia , cardiology , pathophysiology , surgery , pregnancy , pathology , genetics , physics , alternative medicine , acoustics , loudspeaker , biology
Congenital diaphragmatic hernia (CDH) is a rare developmental defect of the diaphragm, characterized by herniation of abdominal contents into the chest that results in varying degrees of pulmonary hypoplasia and pulmonary hypertension (PH). Significant advances in the prenatal diagnosis and identification of prognostic factors have resulted in the continued refinement of the approach to fetal therapies for CDH. Postnatally, protocolized approaches to lung-protective ventilation, nutrition, prevention of infection, and early aggressive management of PH have led to improved outcomes in infants with CDH. Advances in our understanding of the associated left ventricular (LV) hypoplasia and myocardial dysfunction in infants with severe CDH have allowed for the optimization of hemodynamics and management of PH. This article provides a comprehensive review of CDH for the anesthesiologist, focusing on the complex pathophysiology, advances in prenatal diagnosis, fetal interventions, and optimal postnatal management of CDH.