{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T01:00:44Z","timestamp":1780275644681,"version":"3.54.0"},"reference-count":148,"publisher":"American Academy of Pediatrics (AAP)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,6,1]]},"abstract":"<jats:p>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.<\/jats:p>","DOI":"10.1542\/neo.27-6-019","type":"journal-article","created":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T00:04:15Z","timestamp":1780272255000},"page":"e337-e354","source":"Crossref","is-referenced-by-count":0,"title":["Evolving Approaches to Congenital Diaphragmatic Hernia Management"],"prefix":"10.1542","volume":"27","author":[{"given":"Abby C.","family":"Larson","sequence":"first","affiliation":[{"name":"1Division of Pediatric Surgery, Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado"},{"name":"2Colorado Fetal Care Center, Children\u2019s Hospital Colorado, Aurora, Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason","family":"Gien","sequence":"additional","affiliation":[{"name":"3Section of Neonatology, Department of Pediatrics, University of Colorado School of Medicine and Children\u2019s Hospital Colorado, Aurora, Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S. Christopher","family":"Derderian","sequence":"additional","affiliation":[{"name":"1Division of Pediatric Surgery, Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado"},{"name":"2Colorado Fetal Care Center, Children\u2019s Hospital Colorado, Aurora, Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2026,6,1]]},"reference":[{"issue":"9","key":"2026053120041139500_r1","first-page":"1308","article-title":"Incidence and mortality trends in congenital diaphragmatic hernia in the United States","volume":"53","author":"Shah","year":"2025","journal-title":"J Perinat Med."},{"issue":"11","key":"2026053120041139500_r2","first-page":"501","article-title":"Long term outcomes in CDH: cardiopulmonary outcomes and health related quality of life","volume":"57","author":"Lewis","year":"2022","journal-title":"J Pediatr Surg."},{"issue":"9","key":"2026053120041139500_r3","first-page":"1347","article-title":"Comparison of current to past outcomes in congenital diaphragmatic hernia using MRI observed-to-expected total fetal lung volume","volume":"44","author":"Yang","year":"2024","journal-title":"J Perinatol."},{"issue":"9","key":"2026053120041139500_r4","first-page":"1189","article-title":"Improved survival for infants with severe congenital diaphragmatic hernia","volume":"42","author":"Gien","year":"2022","journal-title":"J Perinatol."},{"issue":"2","key":"2026053120041139500_r5","first-page":"107","article-title":"Randomized trial of fetal surgery for severe left diaphragmatic hernia","volume":"385","author":"Deprest","year":"2021","journal-title":"N Engl J Med."},{"issue":"2","key":"2026053120041139500_r6","first-page":"e000758","article-title":"Long-term follow-up of patients with congenital diaphragmatic hernia","volume":"7","author":"Cimbak","year":"2024","journal-title":"World J Pediatr Surg."},{"issue":"1","key":"2026053120041139500_r7","first-page":"96","article-title":"Long-term outcomes beyond childhood in patients treated for congenital diaphragmatic hernia- a systematic review","volume":"41","author":"Obed","year":"2025","journal-title":"Pediatr Surg Int."},{"issue":"5","key":"2026053120041139500_r8","first-page":"e20162043","article-title":"Congenital diaphragmatic hernia defect size and infant morbidity at discharge","volume":"138","author":"Putnam","year":"2016","journal-title":"Pediatrics."},{"issue":"1","key":"2026053120041139500_r9","first-page":"37","article-title":"Congenital diaphragmatic hernia","volume":"8","author":"Zani","year":"2022","journal-title":"Nat Rev Dis Primers."},{"issue":"4","key":"2026053120041139500_r10","first-page":"643","article-title":"Management advances for congenital diaphragmatic hernia: integrating prenatal and postnatal perspectives","volume":"13","author":"Baschat","year":"2024","journal-title":"Transl Pediatr."},{"issue":"5","key":"2026053120041139500_r11","first-page":"676","article-title":"Observed\/expected lung-to-head ratio and total lung volumes that identify fetuses with severe congenital diaphragmatic hernia in a North American fetal center","volume":"45","author":"Gebb","year":"2025","journal-title":"Prenat Diagn."},{"key":"2026053120041139500_r12","first-page":"168","article-title":"Risk stratification by percent liver herniation in congenital diaphragmatic hernia","volume":"282","author":"Olutoye","year":"2023","journal-title":"J Surg Res."},{"issue":"1","key":"2026053120041139500_r13","first-page":"162734","article-title":"Right-sided congenital diaphragmatic hernia: characterization, utility of prenatal imaging predictors and outcomes","volume":"61","author":"Eason","year":"2026","journal-title":"J Pediatr Surg."},{"issue":"4","key":"2026053120041139500_r14","first-page":"238","article-title":"A machine learning approach to predict mortality and neonatal persistent pulmonary hypertension in newborns with congenital diaphragmatic hernia. A retrospective observational cohort study","volume":"184","author":"Conte","year":"2025","journal-title":"Eur J Pediatr."},{"issue":"3","key":"2026053120041139500_r15","first-page":"354","article-title":"Observed-to-expected lung-area-to-head-circumference ratio on ultrasound examination vs total fetal lung volume on magnetic resonance imaging in prediction of survival in fetuses with left-sided diaphragmatic hernia","volume":"64","author":"D\u00fctemeyer","year":"2024","journal-title":"Ultrasound Obstet Gynecol."},{"issue":"7","key":"2026053120041139500_r16","first-page":"658","article-title":"The validity of the observed-to-expected lung-to-head ratio in congenital diaphragmatic hernia in an era of standardized neonatal treatment; a multicenter study","volume":"37","author":"Snoek","year":"2017","journal-title":"Prenat Diagn."},{"issue":"1","key":"2026053120041139500_r17","first-page":"6","article-title":"Congenital diaphragmatic hernia - a 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hernia","volume":"30","author":"Jani","year":"2007","journal-title":"Ultrasound Obstet Gynecol."},{"issue":"6","key":"2026053120041139500_r21","first-page":"771","article-title":"Variability in antenatal prognostication of congenital diaphragmatic hernia by magnetic resonance imaging across the North American Fetal Therapy Network (NAFTNet)","volume":"65","author":"Abbasi","year":"2025","journal-title":"Ultrasound Obstet Gynecol."},{"issue":"5","key":"2026053120041139500_r22","first-page":"688","article-title":"Prenatal MRI fetal lung volumes and percent liver herniation predict pulmonary morbidity in congenital diaphragmatic hernia (CDH)","volume":"49","author":"Zamora","year":"2014","journal-title":"J Pediatr Surg."},{"issue":"3","key":"2026053120041139500_r23","first-page":"23","article-title":"Prenatal predictors of survival in isolated congenital diaphragmatic hernia: a systematic review and meta-analysis","volume":"1","author":"Tofte","year":"2024","journal-title":"O G 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measured on fetal magnetic resonance imaging: a useful biometric parameter for risk stratification in congenital diaphragmatic hernia","volume":"42","author":"Barnewolt","year":"2007","journal-title":"J Pediatr Surg."},{"issue":"6","key":"2026053120041139500_r28","first-page":"933","article-title":"Percent predicted lung volume changes on fetal magnetic resonance imaging throughout gestation in congenital diaphragmatic hernia","volume":"52","author":"Shieh","year":"2017","journal-title":"J Pediatr Surg."},{"key":"2026053120041139500_r29","first-page":"115821","article-title":"Fetal biophysical predictors of pulmonary hypertension severity, management, and treatment in infants born with congenital diaphragmatic hernia","volume":"236","author":"Chase Binion","year":"2024","journal-title":"Am J Surg."},{"issue":"6","key":"2026053120041139500_r30","first-page":"e86502","article-title":"Prenatal interventions for congenital diaphragmatic hernia: a systematic 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Surg."},{"key":"2026053120041139500_r34","first-page":"336","article-title":"Extracorporeal membrane oxygenation in congenital diaphragmatic hernia","volume":"7","author":"Rafat","year":"2019","journal-title":"Front Pediatr."},{"issue":"9","key":"2026053120041139500_r35","first-page":"1340","article-title":"Hydrops and congenital diaphragmatic hernia: reported incidence and postnatal outcomes. 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Diagn."},{"key":"2026053120041139500_r39","first-page":"13","article-title":"Evidence-based genetic testing for individuals with congenital diaphragmatic hernia (CDH)","volume":"248","author":"Gofin","year":"2022","journal-title":"J Pediatr."},{"issue":"4","key":"2026053120041139500_r40","first-page":"560.e1","article-title":"The randomized Tracheal Occlusion to Accelerate Lung Growth (TOTAL)-trials on fetal surgery for congenital diaphragmatic hernia: reanalysis using pooled data","volume":"226","author":"Van Calster","year":"2022","journal-title":"Am J Obstet Gynecol."},{"key":"2026053120041139500_r41","first-page":"852843","article-title":"Challenges and pitfalls: performing clinical trials in patients with congenital diaphragmatic hernia","volume":"10","author":"Cochius-den Otter","year":"2022","journal-title":"Front Pediatr."},{"issue":"6","key":"2026053120041139500_r42","first-page":"778","article-title":"Fetal endoscopic tracheal occlusion (FETO) for left and right congenital diaphragmatic hernia in Canada","volume":"45","author":"Kunpalin","year":"2025","journal-title":"Prenat Diagn."},{"issue":"2","key":"2026053120041139500_r43","first-page":"119","article-title":"Randomized trial of fetal surgery for moderate left diaphragmatic hernia","volume":"385","author":"Deprest","year":"2021","journal-title":"N Engl J Med."},{"issue":"3","key":"2026053120041139500_r44","first-page":"378","article-title":"Fetal endoscopic tracheal occlusion reverses the natural history of right-sided congenital diaphragmatic hernia: European multicenter experience","volume":"57","author":"Russo","year":"2021","journal-title":"Ultrasound Obstet Gynecol."},{"issue":"3","key":"2026053120041139500_r45","first-page":"239","article-title":"Diagnosis and management of congenital diaphragmatic hernia: a 2023 update from the Canadian Congenital Diaphragmatic Hernia Collaborative","volume":"109","author":"Puligandla","year":"2024","journal-title":"Arch Dis Child Fetal Neonatal Ed."},{"issue":"8","key":"2026053120041139500_r46","first-page":"1592","article-title":"Expert surgical consensus for prenatal counseling using the Delphi method","volume":"53","author":"Berman","year":"2018","journal-title":"J Pediatr Surg."},{"issue":"3","key":"2026053120041139500_r47","first-page":"445","article-title":"The impact of comprehensive fetal care on mortality of children with congenital diaphragmatic hernia when delivery is co-located in a pediatric hospital","volume":"59","author":"Goldshore","year":"2024","journal-title":"J Pediatr Surg."},{"issue":"9","key":"2026053120041139500_r48","first-page":"162399","article-title":"Hospital volume and outcome in the treatment of congenital diaphragmatic hernia in Germany - observational study using national hospital discharge data from 2016 to 2023","volume":"60","author":"Elrod","year":"2025","journal-title":"J Pediatr Surg."},{"key":"2026053120041139500_r49","first-page":"245","article-title":"Inborn versus outborn delivery in neonates with congenital diaphragmatic hernia","volume":"270","author":"Stopenski","year":"2022","journal-title":"J Surg Res."},{"issue":"12","key":"2026053120041139500_r50","first-page":"e705","article-title":"Congenital diaphragmatic hernia: maximizing survival","volume":"17","author":"Weems","year":"2016","journal-title":"Neoreviews."},{"issue":"2","key":"2026053120041139500_r51","first-page":"113","article-title":"Management of congenital diaphragmatic hernia treated with extracorporeal life support: interim guidelines consensus statement from the Extracorporeal Life Support Organization","volume":"67","author":"Guner","year":"2021","journal-title":"ASAIO J."},{"issue":"1","key":"2026053120041139500_r52","first-page":"20","article-title":"A randomized controlled trial of fetal endoscopic tracheal occlusion versus postnatal management of severe isolated congenital diaphragmatic hernia","volume":"39","author":"Ruano","year":"2012","journal-title":"Ultrasound Obstet Gynecol."},{"key":"2026053120041139500_r53","first-page":"92","article-title":"Simulation training for urgent postnatal fetal tracheal balloon removal: two learning methods","volume":"281","author":"Lehoczky","year":"2023","journal-title":"Eur J Obstet Gynecol Reprod Biol."},{"issue":"9","key":"2026053120041139500_r54","first-page":"1533","article-title":"Prenatal diagnosis of congenital diaphragmatic hernia: how should the babies be delivered?","volume":"42","author":"Frenckner","year":"2007","journal-title":"J Pediatr Surg."},{"issue":"5","key":"2026053120041139500_r55","first-page":"854","article-title":"The ex-utero intrapartum treatment (EXIT) strategy for congenital diaphragmatic hernia in a twin pregnancy: a case report and literature review","volume":"64","author":"Chen","year":"2025","journal-title":"Taiwan J Obstet Gynecol."},{"issue":"6","key":"2026053120041139500_r56","first-page":"968","article-title":"Optimal gestational age at delivery in isolated left-sided congenital diaphragmatic hernia","volume":"57","author":"Bouchghoul","year":"2021","journal-title":"Ultrasound Obstet Gynecol."},{"issue":"9","key":"2026053120041139500_r57","first-page":"1247","article-title":"Golden hour management of infants with congenital diaphragmatic hernia: 15\u00a0year experience at a high-volume center","volume":"45","author":"Wild","year":"2025","journal-title":"J Perinatol."},{"issue":"2","key":"2026053120041139500_r58","first-page":"e000789","article-title":"Lung-protective ventilation in the management of congenital diaphragmatic hernia","volume":"7","author":"Traynor","year":"2024","journal-title":"World J Pediatr Surg."},{"issue":"3","key":"2026053120041139500_r59","first-page":"357","article-title":"Congenital diaphragmatic hernia in 120 infants treated consecutively with permissive hypercapnea\/spontaneous respiration\/elective repair","volume":"37","author":"Boloker","year":"2002","journal-title":"J Pediatr Surg."},{"issue":"1","key":"2026053120041139500_r60","first-page":"98","article-title":"The VICI-trial: high frequency oscillation versus conventional mechanical ventilation in newborns with congenital diaphragmatic hernia: an international multicentre randomized controlled trial","volume":"11","author":"van den Hout","year":"2011","journal-title":"BMC Pediatr."},{"issue":"5","key":"2026053120041139500_r61","first-page":"867","article-title":"Conventional mechanical ventilation versus high-frequency oscillatory ventilation for congenital diaphragmatic hernia: a randomized clinical trial (the VICI-trial)","volume":"263","author":"Snoek","year":"2016","journal-title":"Ann Surg."},{"issue":"9","key":"2026053120041139500_r62","first-page":"1353","article-title":"Association between initial ventilation mode and hospital outcomes for severe congenital diaphragmatic hernia","volume":"44","author":"Wild","year":"2024","journal-title":"J Perinatol."},{"issue":"6","key":"2026053120041139500_r63","first-page":"935","article-title":"Left-sided congenital diaphragmatic hernia: can we improve survival while decreasing ECMO?","volume":"40","author":"Yang","year":"2020","journal-title":"J Perinatol."},{"issue":"12","key":"2026053120041139500_r64","first-page":"1522","article-title":"Ventricular dysfunction is a critical determinant of mortality in congenital diaphragmatic hernia","volume":"200","author":"Patel","year":"2019","journal-title":"Am J Respir Crit Care Med."},{"key":"2026053120041139500_r65","first-page":"1356157","article-title":"Diagnosis, management and long term cardiovascular outcomes of phenotypic profiles in pulmonary hypertension associated with congenital diaphragmatic hernia","volume":"12","author":"Chaudhari","year":"2024","journal-title":"Front Pediatr."},{"issue":"2","key":"2026053120041139500_r66","first-page":"123","article-title":"Pulmonary vasodilator therapy in congenital diaphragmatic hernia: acute, late, and chronic pulmonary hypertension","volume":"29","author":"Kinsella","year":"2005","journal-title":"Semin Perinatol."},{"issue":"4","key":"2026053120041139500_r67","first-page":"151437","article-title":"Congenital diaphragmatic hernia-associated pulmonary hypertension","volume":"33","author":"Holden","year":"2024","journal-title":"Semin Pediatr Surg."},{"key":"2026053120041139500_r68","first-page":"17","article-title":"The left ventricle in congenital diaphragmatic hernia: implications for the management of pulmonary hypertension","volume":"197","author":"Kinsella","year":"2018","journal-title":"J Pediatr."},{"issue":"5","key":"2026053120041139500_r69","first-page":"993","article-title":"Diminished cardiac performance and left ventricular dimensions in neonates with congenital diaphragmatic hernia","volume":"39","author":"Altit","year":"2018","journal-title":"Pediatr Cardiol."},{"key":"2026053120041139500_r70","first-page":"28","article-title":"Ventricular performance is associated with need for extracorporeal membrane oxygenation in newborns with congenital diaphragmatic hernia","volume":"191","author":"Altit","year":"2017","journal-title":"J Pediatr."},{"issue":"4","key":"2026053120041139500_r71","first-page":"808","article-title":"Extracorporeal life support in patients with congenital diaphragmatic hernia: how long should we treat?","volume":"218","author":"Kays","year":"2014","journal-title":"J Am Coll Surg."},{"issue":"6","key":"2026053120041139500_r72","first-page":"785","article-title":"Development and validation of extracorporeal membrane oxygenation mortality-risk models for congenital diaphragmatic hernia","volume":"64","author":"Guner","year":"2018","journal-title":"ASAIO J."},{"issue":"2","key":"2026053120041139500_r73","first-page":"e413","article-title":"A clinical prediction rule for the severity of congenital diaphragmatic hernias in 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analysis","volume":"44","author":"Heiwegen","year":"2020","journal-title":"World J Surg."},{"issue":"4","key":"2026053120041139500_r78","first-page":"638","article-title":"Long-term maturation of congenital diaphragmatic hernia treatment results: toward development of a severity-specific treatment algorithm","volume":"258","author":"Kays","year":"2013","journal-title":"Ann Surg."},{"issue":"9","key":"2026053120041139500_r79","first-page":"1656","article-title":"The timing of congenital diaphragmatic hernia repair on extracorporeal membrane oxygenation impacts surgical bleeding risk","volume":"58","author":"Smithers","year":"2023","journal-title":"J Pediatr Surg."},{"key":"2026053120041139500_r80","first-page":"198","article-title":"A perioperative bivalirudin anticoagulation protocol for neonates with congenital diaphragmatic hernia on extracorporeal membrane oxygenation","volume":"193","author":"Snyder","year":"2020","journal-title":"Thromb 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