Congenital Diaphragmatic Hernia Repair

Congenital diaphragmatic hernia is an embryologic defect in diaphragm formation that allows abdominal contents to enter into the fetal pleural cavity, resulting in ipsilateral lung compression, pulmonary hypoplasia, and abnormal pulmonary vasculature. Though diagnosis is frequently made on prenatal imaging, the diagnosis should be considered in any newborn with respiratory distress. Prenatal predictors of defect severity include evaluation of observed-to-expected lung volumes on fetal magnetic resonance imaging and lung-to-head ratio on fetal ultrasound. Treatment focuses on medical stabilization, including optimization of oxygenation and ventilation, followed by surgical repair. Anesthetic considerations for these patients include management of coexisting cardiac disease and ventilatory parameters, in addition to standard neonatal anesthetic considerations.