Postnatal management of preterm infants with congenital diaphragmatic hernia
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In brief
In brief
Retrospective study of 32 preterm infants with CDH managed in a quaternary NICU, with 44% having undergone fetal FETO therapy. Overall survival to discharge was 59%, with median surgical repair at 10 days of life and significant morbidity including prolonged ventilation and need for home oxygen in survivors.
- Preterm CDH is increasingly common due to FETO therapy, with 44% of this cohort undergoing antenatal tracheal occlusion.
- Survival to discharge was 59% in preterm CDH infants (median GA 34 weeks), indicating high mortality risk in this population.
- Median time to surgical repair was 10 days, suggesting delayed intervention is feasible in stabilized preterm CDH patients.
- IVH risk remains low (6% grade 3-4) despite prematurity, but 26% of survivors required home oxygen at discharge.
- Standardized management protocols for preterm CDH are lacking; multicenter studies needed to optimize timing of repair and ventilation strategies.
Written by the GCMD Library team from the article.
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.