Congenital diaphragmatic hernia

Pergialiotis V, Theodora M, Papazeukos V, Antsaklis A.

1st Dpt. of Obstetrics and Gynecology, Athens University, Medical School, Alexandra Hospital

Correspondence: Pergialiotis V, 6 Danaidon str., Chalandri 15232, Αthens

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Abstract

Congenital diaphragmatic hernia is defined as the prolapse of abdominal viscera or parietal peritoneum in the thoracic cavity through a gap in the diaphragm. The incidence in the general population is 1 in 2500 births while the rate of neonatal morbidity depends on the degree of prolapse of intra-abdominal viscera and the hypoplasia of the lung and ranges between asymptomatic and severe respiratory distress of the newborn. While the causes have not been clarified it appears to be multifactorial as observed in familial forms and in teratotoxic experimental models. Lung hypoplasia seems to be based on a double hit to the development of the lungs which is determined genetically, followed by the pressure effects of the herniated abdominal viscera. Prenatal diagnosis of CDH is nowadays possible and renders possible both the intrauterine fetal therapy, and the possibility of intensive resuscitation of the newborn immediately after birth, before the installation of acidosis. The challenges however remain in the prenatal determination of survival of the newborn and the establishment of management protocols for treatment both in utero and after birth.

Key words: diaphragmatic hernia; congenital; lung to head ratio.