Document Detail


Congenital diaphragmatic hernia: review of the literature in reflection of unresolved dilemmas.
MedLine Citation:
PMID:  19627259     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Congenital diaphragmatic hernia (CDH) is a rare but clinically and scientifically challenging condition. The introduction of ultrasound has enabled early prenatal detection and consequently, hope of early therapeutic intervention. AIM: We undertook the task to review the recent developments in understanding the pathology of CDH as well as the history and current management strategies to aid perinatologists in consultations with parents of CDH-affected foetuses. STUDY DESIGN: A Medline search was undertaken of all reports and reviews published between 1980 and 2008 using MeSH search terms 'diaphragmatic hernia', 'congenital' and 'newborn'. RESULTS: The true incidence of CDH is still difficult to estimate because of the high incidence of hidden mortality of CDH. Complete case ascertainment also poses difficulties in assessment of the impact of new therapeutic modalities on overall survival. Recent improvements in prenatal detection are a milestone in affording time for re-assessments and parental counselling. The true benefit of antenatal therapy is circumscribed and should be offered only in selected cases of isolated severe CDH as defined by existing guidelines. Postnatal intensive respiratory supportive therapy and innovative surgical techniques within specialized tertiary centres has had a major impact on survival of babies with CDH. CONCLUSION: The high survival of 'selected cases' that are live births and benefit from optimal care will be difficult to improve by antenatal interventions. The multidisciplinary approach to basic research and randomized clinical trials will further define the best approach to the foetus and neonate with CDH.
Authors:
S Grisaru-Granovsky; R Rabinowitz; A Ioscovich; D Elstein; M S Schimmel
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Publication Detail:
Type:  Journal Article; Review     Date:  2009-07-20
Journal Detail:
Title:  Acta paediatrica (Oslo, Norway : 1992)     Volume:  98     ISSN:  1651-2227     ISO Abbreviation:  Acta Paediatr.     Publication Date:  2009 Dec 
Date Detail:
Created Date:  2010-01-06     Completed Date:  2010-02-02     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9205968     Medline TA:  Acta Paediatr     Country:  Norway    
Other Details:
Languages:  eng     Pagination:  1874-81     Citation Subset:  IM    
Affiliation:
Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Jerusalem, Israel.
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MeSH Terms
Descriptor/Qualifier:
Female
Fetal Diseases / diagnosis,  therapy*
Fetal Therapies / methods
Hernia, Diaphragmatic / congenital*,  diagnosis,  therapy*
Humans
Infant, Newborn
Pregnancy
Prenatal Diagnosis
Prognosis

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