Congenital Diaphragmatic Hernia

Congenital diaphragmatic hernia (CDH) is a common malformation, characterized by a defect in the diaphragm through which the abdominal viscera migrate into the thoracic cavity during fetal life. The incidence of CDH ranges from 1 in 2500–5000 births in recent population-based studies. Approximately 80% of posterolateral diaphragmatic hernia occurs on the left side, 15% are right-sided, and less than 5% are bilateral. The size of the defect varies in size from small (2 or 3 cm) to very large, involving most of the hemidiaphragm. The incidence of associated anomalies has been reported to be about 40% in most series. The most common abnormalities associated with CDH are cardiovascular anomalies, followed by skeletal, central nervous system, genitourinary, gastrointestinal, craniofacial, abdominal wall defects, and chromosomal and syndromic defects. Despite significant advances in neonatal resuscitation and intensive care, associated pulmonary hypoplasia and persistent pulmonary hypertension lead postnatally to severe respiratory distress and contribute to the high morbidity and mortality rates in CDH. Therefore, optimal perioperative stabilization and management by an interdisciplinary team of pediatric surgeons, neonatologists, and anesthetists are crucial for neonates with this potentially life-threatening condition.