Congenital Diaphragmatic Hernia

Congenital diaphragmatic hernia (CDH) occurs in approximately 1 in 3,000–4,000 pregnancies, typically diagnosed at the 20-week anatomy scan when the stomach appears in the same plane as the heart [e303-c1, e303-c2]. CDH represents bilateral lung growth arrest beginning at 14–15 weeks gestation, with the ipsilateral lung more severely affected; at birth, pulmonary hypoplasia and altered pulmonary vascular resistance dominate the physiology [e303-c3, e303-c4]. CDH is a medical emergency, not a surgical emergency; delivery should occur at a tertiary center with ECMO capability, though only 10–15% of infants will require ECMO [e303-c6, e303-c9]. Survival for isolated CDH is 80–85% . Management prioritizes preductal oxygenation with permissive hypercapnia, unconventional high-rate low-pressure ventilation, and avoidance of paralysis [e303-c22, e303-c27, e303-c25]. Nitric oxide offers no benefit . Repair timing depends on hemodynamic stability, typically 3–4 days for non-ECMO patients . Thoracoscopic repair shows 25% recurrence rates versus lower rates with open repair, though it reduces bowel obstruction [e303-c61, e338-c5, e10554-c4]. CDH is a field defect affecting the entire foregut, causing lifelong esophageal dysmotility, increased risk of Barrett's esophagitis, neurodevelopmental issues, chest wall asymmetry, and scoliosis; multidisciplinary longitudinal follow-up is essential [e303-c77, e303-c83, e303-c84, e303-c85, e303-c87].