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Recent advances in the treatment of complex congenital diaphragmatic hernia—a narrative review

BACKGROUND AND OBJECTIVE: Congenital diaphragmatic hernia (CDH) is an anomaly of the cardiopulmonary system maturation process that results from both a global embryopathy and concomitant mechanical compression of the cardiopulmonary system from the abdominal contents during fetal maturation. This re...

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Autores principales: Holden, Kylie I., Harting, Matthew T.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: AME Publishing Company 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10416132/
https://www.ncbi.nlm.nih.gov/pubmed/37575897
http://dx.doi.org/10.21037/tp-23-240
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author Holden, Kylie I.
Harting, Matthew T.
author_facet Holden, Kylie I.
Harting, Matthew T.
author_sort Holden, Kylie I.
collection PubMed
description BACKGROUND AND OBJECTIVE: Congenital diaphragmatic hernia (CDH) is an anomaly of the cardiopulmonary system maturation process that results from both a global embryopathy and concomitant mechanical compression of the cardiopulmonary system from the abdominal contents during fetal maturation. This results in pulmonary hypertension, pulmonary hypoplasia, and cardiac dysfunction, requiring intense critical care management. The patients with highest risk CDH are the most challenging, resource-intensive, and bear most of the mortality. Advances at the basic, translational, and clinical research levels are leading to novel therapies and management strategies for complex, high-risk CDH. Our objective is to review novel approaches in thinking and management for the most complex and high-risk CDH patients. These include patients with prenatal and postnatal indicators of high-risk defects, those receiving extracorporeal life support (ECLS), and those with concomitant anomalies such as complex cardiac and/or chromosomal abnormalities. METHODS: PubMed was searched in late 2022 and early 2023 to identify relevant evidence. Search terms included congenital diaphragmatic hernia (CDH)”, “extracorporeal life support (ECLS)”, “pulmonary hypertension”, “dual-hit hypothesis”, “risk reduction”, “cardiac/chromosomal anomalies”, and “novel therapies”. We included trials, multicenter studies (prospective and retrospective), single-center reports, and review articles/expert opinion. KEY CONTENT AND FINDINGS: CDH is a congenital anomaly of the cardiopulmonary and diaphragmatic systems that represents a spectrum of disease. High-risk or complex patients are defined by prenatal/postnatal risk stratification, receipt of ECLS, and/or having concomitant anomalies, representing the severe end of that spectrum. Overall survival of high-risk CDH is about 50% and comprises the vast majority of mortality, mandating special emphasis. The development of risk-stratification processes, best practices or guidelines of management, and novel therapies is critical to optimize the care of these infants. CONCLUSIONS: CDH patients with high-risk disease remain a challenging subset of CDH patients. Increasing opportunities for survival are being realized with novel, investigational approaches.
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spelling pubmed-104161322023-08-12 Recent advances in the treatment of complex congenital diaphragmatic hernia—a narrative review Holden, Kylie I. Harting, Matthew T. Transl Pediatr Review Article BACKGROUND AND OBJECTIVE: Congenital diaphragmatic hernia (CDH) is an anomaly of the cardiopulmonary system maturation process that results from both a global embryopathy and concomitant mechanical compression of the cardiopulmonary system from the abdominal contents during fetal maturation. This results in pulmonary hypertension, pulmonary hypoplasia, and cardiac dysfunction, requiring intense critical care management. The patients with highest risk CDH are the most challenging, resource-intensive, and bear most of the mortality. Advances at the basic, translational, and clinical research levels are leading to novel therapies and management strategies for complex, high-risk CDH. Our objective is to review novel approaches in thinking and management for the most complex and high-risk CDH patients. These include patients with prenatal and postnatal indicators of high-risk defects, those receiving extracorporeal life support (ECLS), and those with concomitant anomalies such as complex cardiac and/or chromosomal abnormalities. METHODS: PubMed was searched in late 2022 and early 2023 to identify relevant evidence. Search terms included congenital diaphragmatic hernia (CDH)”, “extracorporeal life support (ECLS)”, “pulmonary hypertension”, “dual-hit hypothesis”, “risk reduction”, “cardiac/chromosomal anomalies”, and “novel therapies”. We included trials, multicenter studies (prospective and retrospective), single-center reports, and review articles/expert opinion. KEY CONTENT AND FINDINGS: CDH is a congenital anomaly of the cardiopulmonary and diaphragmatic systems that represents a spectrum of disease. High-risk or complex patients are defined by prenatal/postnatal risk stratification, receipt of ECLS, and/or having concomitant anomalies, representing the severe end of that spectrum. Overall survival of high-risk CDH is about 50% and comprises the vast majority of mortality, mandating special emphasis. The development of risk-stratification processes, best practices or guidelines of management, and novel therapies is critical to optimize the care of these infants. CONCLUSIONS: CDH patients with high-risk disease remain a challenging subset of CDH patients. Increasing opportunities for survival are being realized with novel, investigational approaches. AME Publishing Company 2023-07-06 2023-07-31 /pmc/articles/PMC10416132/ /pubmed/37575897 http://dx.doi.org/10.21037/tp-23-240 Text en 2023 Translational Pediatrics. All rights reserved. https://creativecommons.org/licenses/by-nc-nd/4.0/Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) .
spellingShingle Review Article
Holden, Kylie I.
Harting, Matthew T.
Recent advances in the treatment of complex congenital diaphragmatic hernia—a narrative review
title Recent advances in the treatment of complex congenital diaphragmatic hernia—a narrative review
title_full Recent advances in the treatment of complex congenital diaphragmatic hernia—a narrative review
title_fullStr Recent advances in the treatment of complex congenital diaphragmatic hernia—a narrative review
title_full_unstemmed Recent advances in the treatment of complex congenital diaphragmatic hernia—a narrative review
title_short Recent advances in the treatment of complex congenital diaphragmatic hernia—a narrative review
title_sort recent advances in the treatment of complex congenital diaphragmatic hernia—a narrative review
topic Review Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10416132/
https://www.ncbi.nlm.nih.gov/pubmed/37575897
http://dx.doi.org/10.21037/tp-23-240
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