Emma Williams, Stephanie Lau, Nimrah Abbasi, Eveline Lapidus-Krol, Priscilla P. L. Chiu, Brian T. Kalish
Hospital for Sick Children and University of Toronto. Mount Sinai Hospital.
Canada
Pediatric Surgery International
Pediatr Surg Int 2025; 41:
DOI: 10.1007/s00383-025-05964-5
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.
Category
Class III. Pulmonary Hypertension Associated with Lung Hypoplasia
Class III. Pulmonary Hypertension Associated with Lung Disease
Age Focus: Pediatric Pulmonary Vascular Disease
Fresh or Filed Publication: Fresh (PHresh). Less than 1-2 years since publication
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