Congenital diaphragmatic hernia natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Arooj Naz, M.B.B.S
Overview
Natural History
Complications
In many neonates, there is an initial period of 24-48 hours of stability after which acute respiratory distress develops. Pulmonary hypoplasia is a common complication amongst almost all affected children.[1] Major complications include:
- Tracheobronchomalacia
- Pneumothorax
- Pulmonary Hypertension
- Pulmonary infection; especially viral pneumonia and aspiration pneumonia
- Respiratory failure
- Reduced exercise tolerance
- Stunted growth due to aversion to oral feeding
- Gastroesophageal reflux [2]
- Chest asymmetry, pectus excavatum and scoliosis following surgical repair of the chest wall
- Sensorineural hearing loss [3]
Prognosis
A diaphragmatic hernia is a very serious disorder. The outcome of surgery depends on how well your baby's lungs have developed. Usually the outlook is very good for infants who have enough lung tissue. Affected infants often require mechanical ventilation and oxygenation, followed by the use of diuretics after surgical correction. The use of oxygen and diuretics can be discontinued, often within the first two years of life.[1] For children presenting with intermittent wheezing, bronchodilators are required. Some children require continued nutritional supplements. With advances in neonatal and surgical care, survival is now greater than 80%.