Congenital diaphragmatic hernia. Part II.

The infant with a congenital diaphragmatic hernia presents many challenges to those caring for him. A thorough understanding of both anatomic and physiologic components can enable the caregiver to accurately assess the patient and employ interventions which will minimize complications. Part I of this article discussed the incidence, mortality, embryology, diagnosis, pathophysiology, and conventional management. This article discusses alternatives to conventional management, outcome predictors, current research and follow-up of the infant with congenital diaphragmatic hernia. Recent advances in the use of non-conventional treatment, especially ECMO, for infants with diaphragmatic hernias have proven successful. Infants having risk factors associated with 100 percent mortality prior to the advent of ECMO are now surviving. In addition to ECMO, pharmacologic therapy, fetal surgery, lobar transplant, and ventilatory management research show promising results for treatment of the infant with a congenital diaphragmatic hernia.