Congenital diaphragmatic hernia: an unsolved problem.

Despite significant improvements in postnatal care of infants with congenital diaphragmatic hernia (CDH), mortality remains high. Delayed surgery, improved respiratory support, and extracorporeal membrane oxygenation (ECMO) have undoubtedly improved outcome for babies diagnosed after birth, but a prospective study of 52 fetuses with isolated, potentially correctable CDH diagnosed prior to 25 weeks gestation showed that 60% died despite optimal care presently available after birth. Repair of CDH before birth, although physiologically compelling, has proven exceedingly difficult especially when the fetal liver is incarcerated in the chest. Our recent experience suggests that intraoperative technical problems are surmountable, but a trial will be necessary to determine if prenatal repair can improve outcome for babies with diaphragmatic hernia.