Collection
Congenital Diaphragmatic Hernia Management
Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
Content of this collection
Excessive torquing of the membranes should be avoided because the scope goes through the abdominal wall and uterine wall, and excessive turning can cause membrane damage. — Beth Rymeski, Fetoscopic endoluminal tracheal occlusion for congenital diaphragmatic hernia · 2:23
FETO Technique2 items
Fetoscopic endoluminal tracheal occlusion for congenital diaphragmatic hernia
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Learn the procedural aspects of Fetoscopic Endoluminal Tracheal Occlusion (FETO) with Beth Rymeski, DO, a Pediatric Surgeon from Cincinnati Children's. This video details the steps of using a fetoscope to insert and inflate a balloon in the
podcast4:30 · Nov 2026
Fetoscopic Tracheal Occlusion for Congenital Diaphragmatic Hernia: Procedural Walkthrough
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This video, presented by Dr. Beth Rymeski of Cincinnati Children's Hospital, details the procedural aspects of Fetal Endoluminal Tracheal Occlusion (FETO). It explains how a fetoscope is used to insert a balloon into the fetal trachea to te
podcast4:30 · Nov 2026
FETO Case Studies2 items
Severe CDH case with FETO: unexpected anatomic findings and clinical outcome
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This video presents a complex case of severe Congenital Diaphragmatic Hernia (CDH) managed with Fetal Endoscopic Tracheal Occlusion (FETO). Dr. Beth Rymeski from Cincinnati Children's discusses the prenatal diagnosis, the FETO procedure, an
podcast3:51 · Nov 2026
FETO procedure for late-diagnosed severe CDH with liver herniation
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This video presents a detailed case study of a 24-year-old mother with a late diagnosis of severe congenital diaphragmatic hernia (CDH) at 28 weeks of gestation. Pediatric Surgeon Dr. Beth Rymeski from Cincinnati Children's Hospital highlig
podcast4:55 · Nov 2026
In the SEER protocol, if pH did not reach 7, PCO2 was not less than 100, and preductal sats were not above 80 within 2 hours, comfort measures only were offered. — Rebecca Stark, ECMO timing and technique for severe congenital diaphragmatic hernia in neonates · 3:04
ECMO Strategies2 items
Timing and anticoagulation strategies for CDH repair on ECMO
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In this session from the 12th Annual Update Course in Pediatric Surgery, Drs. Rebecca Stark and Steven Lee from Seattle Children’s Hospital walk through the timing, technique, and evolving protocols for performing ECMO and surgical repair i
podcast4:55 · Nov 2026
ECMO timing and technique for severe congenital diaphragmatic hernia in neonates
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In this session from the 12th Annual Update Course in Pediatric Surgery, Drs. Rebecca Stark and Steven Lee from Seattle Children’s Hospital walk through the timing, technique, and controversies surrounding ECMO in severe congenital diaphrag
podcast4:43 · Nov 2026
Nutrition and Lung Growth1 item
Postnatal Lung Growth and Nutrition in Congenital Diaphragmatic Hernia Outcomes
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This video provides a comprehensive overview of Congenital Diaphragmatic Hernias (CDH), a significant birth defect. Dr. Paul Kingma from Cincinnati Children's discusses the incidence, prenatal assessment, and key factors influencing prognos
podcast5:30 · Nov 2026
From a cardiovascular standpoint, the old approach was to play it by ear; now every baby gets started on hydrocortisone for blood pressure support. — Paul Kingma, Protocol changes improve CDH survival rates at Cincinnati Children's Hospital · 1:51
Protocol changes improve CDH survival rates at Cincinnati Children's Hospital
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Discover how Cincinnati Children's Hospital implemented protocol changes to significantly improve outcomes for babies with Congenital Diaphragmatic Hernia (CDH). This video details updates in ventilator management, ECMO utilization, blood p
podcast5:22 · Nov 2026
Hirschsprung Dilations, Gastroschisis Management, and CDH Volume Outcomes
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We’re back with 22nd episode of "Quick Literature Updates" the podcast series that delivers the latest updates in pediatric surgery literature in a quick and digestible format. In each episode, we review articles covering the most interesti
podcast4:23 · Nov 2026
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ECMO timing and technique for severe congenital diaphragmatic hernia in neonates
The clinical scenario involves a full-term neonate with known left-sided very severe CDH, no cardiac or genetic anomalies, delivered about an hour ago and intubated per institutional protocols.
clinicalRebecca Stark0:55 ↗
Initial vitals show preductal saturations in the 70s, heart rate 150, blood pressure 35/25 on 100% FIO2, with first gas showing pH 6.8, PaCO2 130, and PaO2 28.
clinicalRebecca Stark1:09 ↗
The majority of centers still do VA ECMO primarily for CDH babies.
epidemiologicalRebecca Stark1:49 ↗
Both VA and VV ECMO are totally reasonable answers for this clinical scenario.
opinionRebecca Stark1:54 ↗
There are lots of benefits to VV ECMO and lots of benefits to VA ECMO.
opinionRebecca Stark1:45 ↗
Based on prenatal imaging showing high risk for needing ECMO, the time to intervene is probably earlier rather than later.
opinionRebecca Stark2:00 ↗
VV cannula availability and concerns with certain VV cannulas have played a role in ECMO modality selection.
opinion2:08 ↗
If an institution does VV ECMO but cannot cannulate because the 13 French cannula is too big, they would probably do VA instead.
clinicalRebecca Stark2:24 ↗
Better VV cannulas are coming out, which may change the numbers of centers using VV ECMO.
opinionRebecca Stark2:24 ↗
Michigan's SEER protocol prenatally selected severe CDH cases and educated parents they would go on this pathway.
guidelineRebecca Stark2:41 ↗
In the SEER protocol, ECMO was on standby in the delivery room, and babies were intubated and resuscitated within 2 hours.
guidelineRebecca Stark2:57 ↗
In the SEER protocol, if pH did not reach 7, PCO2 was not less than 100, and preductal sats were not above 80 within 2 hours, comfort measures only were offered.
guidelineRebecca Stark3:04 ↗
In the SEER protocol, if babies could achieve the resuscitation targets, they were offered ECMO.
Host summaryEm Gootee summarizing the discussion — not the host's own clinical position3:12 ↗
The two groups in the SEER protocol (ECMO versus comfort care) had equivalent survival.
epidemiologicalRebecca Stark3:16 ↗
Half of the patients offered comfort measures in the SEER protocol could have been survivors.
epidemiologicalRebecca Stark3:20 ↗
Half of the patients offered ECMO in the SEER protocol did not survive.
Host summaryEm Gootee summarizing the discussion — not the host's own clinical position3:26 ↗
If you make the decision to choose ECMO versus comfort care beforehand using protocols like SEER, you will be wrong 50% of the time.
opinionRebecca Stark3:30 ↗
With good prenatal counseling and parents who are all in, ECMO should be pursued for every unilateral isolated CDH.
opinionRebecca Stark3:38 ↗
Cases involving genetic or cardiac syndromes are an entirely different scenario from isolated CDH and are not included in the recommendation for universal ECMO.
opinionRebecca Stark3:49 ↗
Fetoscopic endoluminal tracheal occlusion for congenital diaphragmatic hernia
FETO is a percutaneous intervention on the mother using one trocar placed through the maternal abdominal wall into the uterus.
clinicalBeth Rymeski0:33 ↗
A standard fetoscope with a side channel is used, and the balloon is worked through the side channel.
clinicalBeth Rymeski0:36 ↗
The goal of FETO is to trap fluid in the lungs to allow the lungs to expand and grow.
Host summaryJill Knareth summarizes what Dr. Beth Romesky said — not the host's own clinical position0:47 ↗
FETO helps prevent pulmonary hypoplasia, which is a big factor in poor outcomes for CDH babies.
Host summaryJill Knareth summarizes what Dr. Beth Romesky said — not the host's own clinical position0:53 ↗
The tongue is an easy landmark to identify during FETO because it is bumpy.
clinicalBeth Rymeski1:21 ↗
Fluid is hooked up to the scope and can be intermittently turned on and off to push tissue away from the scope to allow easier advancement.
clinicalBeth Rymeski1:29 ↗
If the baby's head is not perfectly aligned with the scope, twisting and turning is required to navigate through the mouth.
clinicalBeth Rymeski1:39 ↗
The epiglottis is sought as a landmark to guide navigation toward the trachea.
clinicalBeth Rymeski1:58 ↗
Excessive torquing of the membranes should be avoided because the scope goes through the abdominal wall and uterine wall, and excessive turning can cause membrane damage.
clinicalBeth Rymeski2:23 ↗
The scope should always be advanced until the carina is visualized, which confirms location in the trachea and not the esophagus.
clinicalBeth Rymeski2:36 ↗
The balloon should not be driven into one side of the trachea; it must be inflated in the main trachea.
clinicalBeth Rymeski2:56 ↗
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