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Research: Antenatal Management of Congenital Diaphragmatic Hernia: what’s next ?

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Research: Antenatal Management of Congenital Diaphragmatic Hernia: what’s next ?

Prenat Diagn

. 2022 Feb 23. doi: 10.1002/pd.6120. Online ahead of print. https://pubmed.ncbi.nlm.nih.gov/35199368/

Antenatal Management of Congenital Diaphragmatic Hernia: what’s next ?

Francesca Russo 1Alexandra Benachi 2Eduard Gratacos 3Augusto Zani 4Richard Keijzer 5Emily Partridge 6Nicolas Sananes 7Paolo De Coppi 8Michael Aertsen 9Kypros H Nicolaides 10Jan Deprest 1 11Affiliations expand

Abstract

Congenital diaphragmatic hernia (CDH) can be diagnosed in the prenatal period and its severity can be measured by fetal imaging. There is now level I evidence that, in selected cases, Fetoscopic Endoluminal Tracheal Occlusion (FETO) increases survival to discharge from the neonatal unit as well as the risk for prematurity. Both effects are dependent on the time point of tracheal occlusion. FETO may also lead to iatrogenic death when done in unexperienced centres. The implementation of the findings from our clinical studies, may also vary based on local conditions. These may be different in terms of available skill set, access to fetal therapy, as well as outcome based on local neonatal management. We encourage prior benchmarking of local outcomes with optimal postnatal management, based on large enough numbers and using identical criteria as in the recent trials. We propose to work further on prenatal prediction methods, and the improvement of fetal intervention. In this manuscript, we describe a research agenda from a fetal medicine perspective. This research should be in parallel with innovation in neonatal and pediatric (surgical) management of this condition. This article is protected by copyright. All rights reserved.

Keywords: congenital diaphragmatic hernia; extracellular vesicles; fetoscopic endoluminal tracheal occlusion; pulmonary hypoplasia; treprostinil.

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