Evolving Approaches to Congenital Diaphragmatic Hernia Management

Congenital diaphragmatic hernia (CDH) is a complex developmental anomaly characterized by pulmonary hypoplasia, abnormal pulmonary vascular development, and variable cardiac dysfunction. Due to advances in neonatal intensive care, center expertise, and surgical repair after physiologic stability, mortality has improved over the past few decades, with survival rates in isolated mild to moderate cases approaching 75% to 90%. This review synthesizes contemporary evidence across the continuum of care for CDH: prenatal diagnosis and imaging; fetal intervention, including fetoscopic endoluminal tracheal occlusion (FETO); delivery planning; postnatal stabilization; ventilatory and hemodynamic management; extracorporeal membrane oxygenation (ECMO); surgical repair; postoperative care; chronic morbidity; and survivorship. Emerging areas include precision prenatal risk stratification, refinement of FETO, harmonized ECMO and surgical guidelines, and long-term multidisciplinary models of care.