[Current and future strategy in the treatment of congenital diaphragmatic hernia].
The severity of congenital diaphragmatic hernia (CDH) depends on the degree of lung hypoplasia. It is still difficult to rescue the most severely affected infants with cardiopulmonary insufficiency immediately after birth. However, the recent treatment strategy has improved the outcome of CDH. High-frequency ventilation (HFV) and gentle ventilation have been reported to be effective in the treatment of CDH by minimizing the barotrauma of the hypoplastic lung. Various vasodilators such as nitric oxide and prostaglandin-E1 have been found to be improve the pulmonary hypertension due to hypoplastic lung. On the other hand, the indications for extracorporeal membrane oxygenation (ECMO), which used to be the most powerful life support for severe CDH, have become limited. In our institute, antenatally diagnosed CDH infants with inadequate oxygenation despite maximum respiratory support immediately after birth are excluded from ECMO candidates because of fatal lung hypoplasia. Recently, it has been reported that temporary tracheal occlusion can accelerate fetal lung growth and improve the outcome of severe CDH. Percutaneous fetal endoluminal tracheal occlusion is expected to become an effective and minimally invasive treatment for fatal lung hypoplasia due to CDH.
Department of Pediatric Surgery, Osaka Medical Center for Maternal and Child Health, Izumi, Japan.
Hiroomi
H
Okuyama
D015199:Extracorporeal Membrane Oxygenation; D006548:Hernia, Diaphragmatic / Q000601:surgery*; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D007231:Infant, Newborn