C Management of congenital diap hragmatic hernia

Current Opinion in Anaesthesiology 2008, 21:323–331 Purpose of review To evaluate the impact of recent research on the management of congenital diaphragmatic hernia in the light of new theories on embryological development, earlie antenatal diagnosis, fetal and postnatal interventions together with advances in perinata intensive care. Recent findings The year 2007 provided in excess of 200 publications that address various aspects o congenital diaphragmatic hernia. The genetic basis and the causes of pulmonary hypoplasia at the molecular level are slowly being unravelled. Fetal MRI of lung volume lung–head ratio, liver position and size of diaphragmatic defect have all been evaluated as early predictors of outcome and with a view to prenatal counselling. The impact o fetal interventions such as fetal endoluminal tracheal occlusion, the mode of delivery, the surgical techniques and agents for treating pulmonary hypertension were evaluated. The influence of associated anomalies and therapeutic interventions on the outcome and quality of life of survivors continue to be appraised. Summary Deferred surgery after stabilization with gentle ventilation and reversal of pulmonary hypertension remain the cornerstones of management. Optimal presurgery and postsurgery ventilatory settings remain unproven. Continued improvement in neonata intensive care raises the bar against which any intervention such as fetal endolumina tracheal occlusion and extracorporeal membrane oxygenation will be judged.