Pediatr Surg Int

. 2025 Jan 16;41(1):67.

 doi: 10.1007/s00383-025-05964-5. https://pubmed.ncbi.nlm.nih.gov/39820658/

Postnatal management of preterm infants with congenital diaphragmatic hernia

Emma E Williams ^1 2, Stephanie Lau ², Nimrah Abbasi ^3 4, Eveline Lapidus-Krol ⁵, Priscilla P L Chiu ^5 6, Brian T Kalish ^7 8

Affiliations Expand

• PMID: 39820658
• DOI: 10.1007/s00383-025-05964-5

Abstract

Introduction: Congenital diaphragmatic hernia (CDH) in the preterm population is increasingly common in the current era of fetal endoluminal tracheal occlusion (FETO) therapy. There remains a lack of clinical guidance for clinicians and surgeons regarding optimal management strategies for such infants. We aimed to describe our experience in managing preterm CDH in a single quaternary neonatal intensive care unit (NICU).

Methods: This was a retrospective single-center observational case series of preterm infants born between 2017 and 2024 at less than 37 weeks of gestation and diagnosed with CDH (pre- or post-natally).

Results: Thirty-two infants with a median (range) gestational age of 33.9 (27.0-36.9) weeks and a birth weight of 1975 (1070-3290) grams. Twenty-two infants (68.8%) were diagnosed with CDH prenatally and 43.8% underwent antenatal FETO. The median time of surgical repair was at 10 (2-47) days of life. The duration of invasive mechanical ventilation was 11 (1-115) days. Nineteen infants (59.4%) survived to discharge with a median postmenstrual age at time of discharge of 40.6 (36.0-51.0) weeks. Two infants developed a grade 3 or 4 intraventricular hemorrhage. Five infants required home oxygen at discharge.

Conclusion: Preterm CDH confers high morbidity and mortality. Robust clinical evidence, multicenter studies and standardized guidelines are needed to improve outcomes in this challenging patient population.

Keywords: Congenital diaphragmatic hernia; Lung hypoplasia; Mechanical ventilation; Prematurity; Pulmonary hypertension.

© 2025. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.