Research: Cardiorespiratory transition in CDH

Semin Fetal Neonatal Med

. 2025 Jul 1:101649.

doi: 10.1016/j.siny.2025.101649. Online ahead of print. https://pubmed.ncbi.nlm.nih.gov/40615338/

Cardiorespiratory transition in CDH

Deepika Sankaran¹, Satyan Lakshminrusimha², Michelle J Lim³

Affiliations Expand

PMID: 40615338
DOI: 10.1016/j.siny.2025.101649

Abstract

Congenital diaphragmatic hernia (CDH) is a rare congenital anomaly that occurs due to incomplete closure of the diaphragm followed by herniation of abdominal contents into the chest. Fetal hemodynamics are altered in CDH due to pulmonary alveolar and vascular hypoplasia, low pulmonary venous return and in some cases, hypoplasia or dysfunction of the left heart. CDH is associated with high risk of morbidity and mortality due to pulmonary hypoplasia and persistent pulmonary hypertension of the newborn secondary to pulmonary vascular hypoplasia and remodeling. Resuscitation in the delivery room involves optimizing cardiopulmonary transition from fetal to neonatal circulation through gentle ventilation, endotracheal intubation and gastric decompression. Infants with CDH often present with hypoxemic respiratory failure in the immediate postnatal period due to pulmonary hypertension. The understanding of critical cardiopulmonary interactions and the distinguishing features of CDH sub-phenotypes and degree of cardiac involvement may aid in an augmented precision-based approach to invasive ventilation, vasoactive use, and ECMO management. Improved survival is reported after fetal in-utero interventions such as fetoscopic endoluminal tracheal occlusion (FETO) with CDH and severe secondary pulmonary hypoplasia. Clinical outcomes can potentially be improved by optimizing cardiopulmonary transition in the delivery room and cardiopulmonary interactions in the immediate the postnatal period.

Keywords: Cardiopulmonary interactions; Fetal circulation; Hypoxia; Hypoxic respiratory failure; Newborn; Oxygen; Pathophysiology of pulmonary hypertension; Pulmonary hypertension.

About The Author

Darlene Silverman

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CDH International

Founded in 1995 as CHERUBS, CDH Research International is a global non-profit working to help over 7000 patient families in 80 countries by raising awareness and supporting Congenital Diaphragmatic Hernia Research.

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