Congenital diaphragmatic hernia.

Congenital diaphragmatic hernia (CDH) can be one of the most clinically challenging neonatal conditions. It occurs in 1 in 2-5000 live births in the UK with no predominance between the sexes. Herniation of abdominal contents into the thorax occurs, however it is the concomitant pulmonary hypoplasia and pulmonary hypertension that can be fatal. CDH was first described as an incidental finding at postmortem in 1679 by Lazarus Riverius. The first successful repair of CDH in a neonate was achieved by Gross in 1946. Despite recent remarkable advances in perioperative neonatal care and surgical techniques, CDH remains a condition with a significantly high mortality rate (31-58%). There is considerable debate about the effectiveness of different therapeutic options. In addition it is apparent that a number of interventions have been introduced without rigorous levels of evidence based medicine. This paper aims to review the controversy and debate in the current management of CDH.