Congenital diaphragmatic hernia

Recent progress of the treatment of congenital diaphragmatic hernia (CDH) is addressed. Early CDH onset within 24 hours of life has been a main concern for neonatologists and pediatric surgeons. Repair of CDH has changed from an emergent procedure to a delayed procedure in the last decade. Employment of new modalities including extracorporeal membrane oxygenation (ECMO), high-frequency oscillatory ventilation (HFO), inhaled NO, and surfactants is decided depending on the situation of each institution. Permissive hypercapnea/spontaneous respiration, more recent style of respiratory management aiming to avoid barotraumas, has reportedly made the outcome much better. Fetal surgery consisting of fetal tracheal occlusion and tracheal repair with ex utero intrapartum treatment (EXIT) has been applied for most serious patients with antenatal diagnosis. It is a promising approach, but recent study failed to demonstrate the improved survival or morbidity rates by tracheal occlusion of the fetuses. Other innovative approaches such as liquid ventilation, minimally invasive surgery, and lung transplantation have begun to be clinically employed. However, the impact of these approaches on the clinical results has not been determined yet. According to the report from the Japanese Society of Pediatric Surgeons, the survival rate of neonates with CDH has improved from 60% to 75% for these 10 years.