Pulmonary Hypoplasia
Everything in the library about pulmonary hypoplasia — built automatically from the recorded discussions that name it
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
Surgical Management
5 items
Controversies in Congenital Diaphragmatic Hernia: Update Course 2018
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At the 6th Annual Pediatric Surgery Update Course, Dr. Mark Wulkan discusses controversies in congenital diaphragmatic hernia including advantages of open versus minimally invasive repair (with visualization of technique), timing of CDH rep
video41:42 · Sep 2018
Approach and component separation for suture closure and underlay mesh...
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During the Pediatric Surgery Tricks of the Trade and Difficult Cases: Innovative Solutions to Common Problems Course in 2013, directors DrsTodd Ponsky, Robert Parry, and Jacob Langer, along with faculty including Drs David van der Zee, Suad
video31:03 · Sep 2018
Tricks - Omphalocele - Approach & Component Separation For Suture Closure &...
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This segment displays a presentation of omphalocele, separation of components and closure of the abdominal wall. The topics discussed include incision placement, component separation, patch closure, ideal time to operate, early versus delay
video32:30 · Nov 2018
Fetoscopic endoluminal tracheal occlusion and twin-twin transfusion: Fetal...
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Dr. Yan Deprest, Professor of Obstetrics GYN, University Hospitals Gasthuisberg. Leuven, Belgium, discusses fetoscopic endoluminal tracheal occlusion. His presentation provides insight on the percutaneous procedure, trocar insertion, delive
video149:16 · Jan 2019
Inside a FETO Procedure: Fetoscopic Balloon Tracheal Occlusion with Dr. Beth Rymeski
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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
video4:30 · Jul 2026
In-Depth Reviews
1 item
Congenital Diaphragmatic Hernia with Dr. Charlie Stolar
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Dr Charlie Stolar discusses key points of CDH with Dr. Todd Ponsky. EDITED BY NICHOLAS BRUNS, MD and IAN GLENN, MD.In this episode, Dr. Charles Stolar from Columbia University College of Physicians and Surgeons and California Pediatric Sur
podcast82:05 · Dec 2020
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Every expert statement below comes from the recorded discussions, with its speaker and moment.
Congenital Diaphragmatic Hernia with Dr. Charlie Stolar
CDH occurs in approximately 1 out of every 3,000-4,000 pregnancies
epidemiologicalCharlie Stolar2:45 ↗
CDH diagnosis is typically made at the 20-week anatomy scan when ultrasonographers see the stomach in the same cross-sectional plane as the heart
clinicalCharlie Stolar3:37 ↗
CDH represents a growth arrest of both lungs, with the ipsilateral side more severely affected than the contralateral side
clinicalCharlie Stolar4:14 ↗
At birth, CDH lungs are affected by a mix of pulmonary hypoplasia and altered pulmonary vascular resistance with altered transitional circulation
clinicalCharlie Stolar4:23 ↗
CDH is a field defect; the most common neonatal comorbidity is foregut motility difficulty
clinicalCharlie Stolar4:39 ↗
CDH is a medical physiologic emergency but not a surgical emergency
clinicalCharlie Stolar5:00 ↗
The diagnosis of CDH alone is not an indication for cesarean section; elective spontaneous vaginal delivery is recommended assuming no obstetric issues
guidelineCharlie Stolar5:24 ↗
Antenatal interventions for CDH are no better than investigational and experimental at best
opinionCharlie Stolar6:35 ↗
Babies with CDH should be born at a full-service children's facility with ECMO capability; maybe 10-15% will benefit from ECMO
guidelineCharlie Stolar7:23 ↗
In single-center experiences, presence of liver in the chest or stomach in the chest is of no prognostic value
clinicalCharlie Stolar8:31 ↗
Lung-to-head ratio is of limited prognostic value except when very low (less than 0.8), where prognosis is concerning
clinicalCharlie Stolar8:42 ↗
Associated congenital heart disease and central nervous system abnormalities augur for poor prognosis
clinicalCharlie Stolar9:07 ↗
If shown 100 children with CDH, 80-85% will survive to become teenagers
epidemiologicalCharlie Stolar10:13 ↗
Antenatal steroids have tremendous value for preterm labor under 35 weeks but most CDH babies are near-term (37-39 weeks) where steroid role is arguable
clinicalCharlie Stolar10:37 ↗
Exit to ECMO for CDH is nonsense; it moves the goalposts on almost certainly non-viable babies
opinionCharlie Stolar12:06 ↗
We are born with about 1/2 to 2/3 of our full complement of alveoli and can grow the balance sometime after birth
clinicalCharlie Stolar13:00 ↗
Initial evaluation of newborn with CDH includes looking for morphology, associated anomalies, respiratory distress, pre- and post-ductal oxygen gradients, and early cardiac echo for right heart function
clinicalCharlie Stolar14:45 ↗
Not every baby with CDH needs or is a candidate for ECMO; approximately 5% have insufficient lung to support life based on inability to saturate preductal blood
clinicalCharlie Stolar15:55 ↗
ECMO is a drug delivery system for oxygen; indication is when end organs aren't getting enough oxygen despite best care
clinicalCharlie Stolar17:06 ↗
The best way to assess end-organ function is urine output
clinicalCharlie Stolar17:44 ↗
ECMO indication is typically oxygenation index in excess of 40 for 4 hours or more
guidelineCharlie Stolar18:21 ↗
All therapy is guided by preductal oximetry, not postductal; if preductal saturation is 90% (PaO2 ~65 torr), the brain is doing fine with fetal hemoglobin
clinicalCharlie Stolar19:06 ↗
When managing dropping preductal saturation, first ensure adequate hemoglobin and circulating volume, then increase FiO2 or ventilator pressure, but avoid trying to control PCO2 as this will destroy the lungs
clinicalCharlie Stolar20:25 ↗
Neonatal ventilators would be thrown out as lethal devices if someone tried to invent them today
opinionCharlie Stolar21:38 ↗
CDH babies are not paralyzed during ventilation; minimal sedation is used and babies should be awake and breathing spontaneously
clinicalCharlie Stolar21:56 ↗
Initial conventional ventilator settings (IMV rate ~40, peak pressure 25-28, PEEP ~5) are not tolerated by most CDH babies
clinicalCharlie Stolar22:15 ↗
Unconventional ventilation mode for CDH uses high rate (100 breaths/min), low peak pressure (turned down to zero due to stacking), and high gas flow rate with permissive hypercapnia
clinicalCharlie Stolar22:53 ↗
High-frequency oscillatory ventilation (HFOV) as rescue therapy rarely spares CDH babies from ECMO; when they get out the oscillator, it's time to prime an ECMO circuit
clinicalCharlie Stolar24:30 ↗
Nitric oxide is a waste of money for CDH; it's terrific for premature babies with immature lung disease but of no value in CDH
opinionCharlie Stolar25:45 ↗
The best drug for CDH is oxygen
opinionCharlie Stolar26:07 ↗
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