{"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":1780275644700,"version":"3.54.0"},"reference-count":104,"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) remains one of the most challenging congenital anomalies encountered by neonatologists and pediatric surgeons, with outcomes largely determined before birth. Although surgical repair of the diaphragmatic defect is essential, postnatal morbidity and mortality are primarily driven by antenatal pulmonary hypoplasia, abnormal pulmonary vascular development, and associated cardiac dysfunction that culminate in respiratory failure and pulmonary hypertension. Advances in prenatal imaging have enabled increasingly refined risk stratification, allowing for the identification of fetuses who are at highest risk for postnatal cardiopulmonary failure. Within this framework, fetal therapies, most notably fetoscopic endoluminal tracheal occlusion, have emerged as the first interventions shown to improve survival in carefully selected cases of severe CDH. However, uncertainty persists regarding optimal patient selection, timing, complications, and the generalizability of outcomes across health care systems. In this review, we examine the pathophysiologic rationale for fetal lung recruitment therapies, contemporary approaches to prenatal diagnosis and severity stratification, and the evidence supporting current fetal interventions. We also discuss how fetal therapy alters postnatal surgical and extracorporeal membrane oxygenation decision-making and highlight emerging prenatal strategies aimed at modifying lung and vascular development before birth. By framing CDH as a prenatal cardiopulmonary disease with postnatal surgical manifestations, we aim to provide a cohesive framework for multidisciplinary counseling, referral, and perioperative planning in the evolving era of fetal therapy.<\/jats:p>","DOI":"10.1542\/neo.27-6-021","type":"journal-article","created":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T00:04:20Z","timestamp":1780272260000},"page":"e369-e381","source":"Crossref","is-referenced-by-count":0,"title":["Risk Stratification and Fetal Therapies for Congenital Diaphragmatic Hernia"],"prefix":"10.1542","volume":"27","author":[{"given":"Connor V.","family":"Haynes","sequence":"first","affiliation":[{"name":"1Yale New Haven Children\u2019s Hospital, Division of Pediatric Surgery, New Haven, Connecticut"},{"name":"2Yale University School of Medicine, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David H.","family":"Stitelman","sequence":"additional","affiliation":[{"name":"1Yale New Haven Children\u2019s Hospital, Division of Pediatric Surgery, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2026,6,1]]},"reference":[{"issue":"3","key":"2026053120041861700_r1","doi-asserted-by":"crossref","first-page":"101652","DOI":"10.1016\/j.siny.2025.101652","article-title":"Developmental pathophysiology and genetic contributions in CDH","volume":"30","author":"Guevara","year":"2025","journal-title":"Semin Fetal Neonatal Med."},{"issue":"7","key":"2026053120041861700_r2","doi-asserted-by":"crossref","first-page":"1271","DOI":"10.1016\/j.jpedsurg.2024.03.041","article-title":"Neurodevelopmental outcomes in children after fetoscopic endoluminal tracheal occlusion for severe congenital diaphragmatic hernia: results from a multidisciplinary clinic","volume":"59","author":"Sferra","year":"2024","journal-title":"J Pediatr Surg."},{"issue":"1","key":"2026053120041861700_r3","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s00383-008-2257-y","article-title":"The long-term follow-up of patients with a congenital diaphragmatic hernia: a broad spectrum of morbidity","volume":"25","author":"Peetsold","year":"2009","journal-title":"Pediatr Surg Int."},{"key":"2026053120041861700_r4","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1017\/CBO9780511545757.013","volume-title":"Pediatric Surgery and Urology: Long-Term Outcomes","author":"Almendinger","year":"2006"},{"issue":"4","key":"2026053120041861700_r5","doi-asserted-by":"crossref","first-page":"671","DOI":"10.1016\/S0095-5108(18)30201-X","article-title":"Congenital diaphragmatic hernia. Epidemiology and outcome","volume":"23","author":"Langham","year":"1996","journal-title":"Clin Perinatol."},{"issue":"6","key":"2026053120041861700_r6","doi-asserted-by":"crossref","first-page":"555","DOI":"10.1002\/tera.1420460605","article-title":"A population-based study of congenital diaphragmatic hernia","volume":"46","author":"Torfs","year":"1992","journal-title":"Teratology."},{"issue":"12","key":"2026053120041861700_r7","doi-asserted-by":"crossref","first-page":"1827","DOI":"10.1016\/j.jpedsurg.2005.08.020","article-title":"Liver position in fetal congenital diaphragmatic hernia retains a prognostic value in the era of lung-protective strategy","volume":"40","author":"Kitano","year":"2005","journal-title":"J Pediatr Surg."},{"issue":"3","key":"2026053120041861700_r8","doi-asserted-by":"crossref","first-page":"101654","DOI":"10.1016\/j.siny.2025.101654","article-title":"Prenatal assessment and prediction in CDH: for what purpose?","volume":"30","author":"Abgral","year":"2025","journal-title":"Semin Fetal Neonatal Med."},{"issue":"2","key":"2026053120041861700_r9","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1007\/s00383-020-04788-9","article-title":"Optimization of surgical timing of congenital diaphragmatic hernia using the quantified flow patterns of patent ductus arteriosus","volume":"37","author":"Shinno","year":"2021","journal-title":"Pediatr Surg Int."},{"key":"2026053120041861700_r10","doi-asserted-by":"crossref","first-page":"114061","DOI":"10.1016\/j.jpeds.2024.114061","article-title":"Congenital diaphragmatic hernia patients with left heart hypoplasia and left ventricular dysfunction have highest odds of mortality","volume":"271","author":"Fraga","year":"2024","journal-title":"J Pediatr."},{"issue":"4","key":"2026053120041861700_r11","doi-asserted-by":"crossref","first-page":"1299","DOI":"10.1016\/S0002-9440(10)65000-6","article-title":"Dual-hit hypothesis explains pulmonary hypoplasia in the nitrofen model of congenital diaphragmatic hernia","volume":"156","author":"Keijzer","year":"2000","journal-title":"Am J Pathol."},{"issue":"2","key":"2026053120041861700_r12","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1002\/ajmg.c.30133","article-title":"Congenital diaphragmatic hernia and pulmonary hypoplasia: new insights from developmental biology and genetics","volume":"145C","author":"Ackerman","year":"2007","journal-title":"Am J Med Genet C Semin Med Genet."},{"issue":"6","key":"2026053120041861700_r13","doi-asserted-by":"crossref","first-page":"L1310","DOI":"10.1152\/ajplung.00257.2002","article-title":"Diaphragm defects occur in a CDH hernia model independently of myogenesis and lung formation","volume":"283","author":"Babiuk","year":"2002","journal-title":"Am J Physiol Lung Cell Mol Physiol."},{"issue":"8","key":"2026053120041861700_r14","doi-asserted-by":"crossref","first-page":"523","DOI":"10.1002\/bdra.20151","article-title":"Congenital diaphragmatic hernia: a retinoid-signaling pathway disruption during lung development?","volume":"73","author":"Gallot","year":"2005","journal-title":"Birth Defects Res A Clin Mol Teratol."},{"issue":"4","key":"2026053120041861700_r15","doi-asserted-by":"crossref","first-page":"912","DOI":"10.1038\/s41390-023-02905-7","article-title":"The etiology of congenital diaphragmatic hernia: the retinoid hypothesis 20\u00a0years later","volume":"95","author":"Rivas","year":"2024","journal-title":"Pediatr Res."},{"issue":"5","key":"2026053120041861700_r16","doi-asserted-by":"crossref","first-page":"832","DOI":"10.1016\/j.jpedsurg.2024.01.034","article-title":"Decreased \u03b2-catenin protein in lungs from human congenital diaphragmatic hernia archival pathology specimens: a case-control study","volume":"59","author":"Prusinkiewicz","year":"2024","journal-title":"J Pediatr Surg."},{"issue":"4","key":"2026053120041861700_r17","doi-asserted-by":"crossref","first-page":"L433","DOI":"10.1152\/ajplung.00316.2022","article-title":"FGF18 promotes human lung branching morphogenesis through regulating mesenchymal progenitor cells","volume":"324","author":"Danopoulos","year":"2023","journal-title":"Am J Physiol Lung Cell Mol Physiol."},{"key":"2026053120041861700_r18","doi-asserted-by":"crossref","first-page":"642577","DOI":"10.3389\/fmed.2021.642577","article-title":"Opposing effects of TGF\u03b2 and BMP in the pulmonary vasculature in congenital diaphragmatic hernia","volume":"8","author":"Mous","year":"2021","journal-title":"Front Med (Lausanne)."},{"issue":"2","key":"2026053120041861700_r19","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1053\/j.sempedsurg.2007.01.002","article-title":"Pulmonary vascular remodeling","volume":"16","author":"Miniati","year":"2007","journal-title":"Semin Pediatr Surg."},{"issue":"1","key":"2026053120041861700_r20","doi-asserted-by":"crossref","first-page":"51163","DOI":"10.1053\/j.semperi.2019.07.002","article-title":"Prenatal diagnosis, imaging, and prognosis in congenital diaphragmatic hernia","volume":"44","author":"Cordier","year":"2020","journal-title":"Semin Perinatol."},{"issue":"1","key":"2026053120041861700_r21","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1002\/uog.4052","article-title":"Observed to expected lung area to head circumference ratio in the prediction of survival in fetuses with isolated diaphragmatic hernia","volume":"30","author":"Jani","year":"2007","journal-title":"Ultrasound Obstet Gynecol."},{"issue":"1","key":"2026053120041861700_r22","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1002\/uog.6141","article-title":"Prenatal prediction of neonatal morbidity in survivors with congenital diaphragmatic hernia: a multicenter study","volume":"33","author":"Jani","year":"2009","journal-title":"Ultrasound Obstet Gynecol."},{"issue":"6","key":"2026053120041861700_r23","doi-asserted-by":"crossref","first-page":"e70119","DOI":"10.1002\/pmf2.70119","article-title":"Early versus late ultrasound and MRI fetal imaging for predicting outcomes in left-sided congenital diaphragmatic hernia","volume":"1","author":"Alamri","year":"2025","journal-title":"Pregnancy."},{"issue":"5","key":"2026053120041861700_r24","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1515\/jpm-2015-0226","article-title":"Fetal magnetic resonance imaging and ultrasound","volume":"44","author":"Wataganara","year":"2016","journal-title":"J Perinat Med."},{"issue":"5","key":"2026053120041861700_r25","doi-asserted-by":"crossref","first-page":"609","DOI":"10.1002\/uog.7586","article-title":"Value of liver herniation in prediction of outcome in fetal congenital diaphragmatic hernia: a systematic review and meta-analysis","volume":"35","author":"Mullassery","year":"2010","journal-title":"Ultrasound Obstet Gynecol."},{"issue":"9","key":"2026053120041861700_r26","doi-asserted-by":"crossref","first-page":"1879","DOI":"10.1016\/j.jpedsurg.2019.11.007","article-title":"Discordant prenatal ultrasound and fetal MRI in CDH: wherein lies the truth?","volume":"55","author":"Kim","year":"2020","journal-title":"J Pediatr Surg."},{"issue":"4","key":"2026053120041861700_r27","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1159\/000512491","article-title":"Reproducibility of lung and liver volume measurements on fetal magnetic resonance imaging in left-sided congenital diaphragmatic hernia","volume":"48","author":"Kolbe","year":"2021","journal-title":"Fetal Diagn Ther."},{"issue":"5","key":"2026053120041861700_r28","doi-asserted-by":"crossref","first-page":"1299","DOI":"10.1007\/s00330-012-2709-6","article-title":"Liver-to-thoracic volume ratio: use at MR imaging to predict postnatal survival in fetuses with isolated congenital diaphragmatic hernia with or without prenatal tracheal occlusion","volume":"23","author":"Cannie","year":"2013","journal-title":"Eur Radiol."},{"key":"2026053120041861700_r29","doi-asserted-by":"crossref","first-page":"102687","DOI":"10.1016\/j.bpobgyn.2025.102687","article-title":"Diagnostic accuracy of prenatal ultrasound and MRI in predicting survival in severe isolated congenital diaphragmatic hernia: a systematic review and meta-analysis","volume":"104","author":"Mustafa","year":"2026","journal-title":"Best Pract Res Clin Obstet Gynaecol."},{"key":"2026053120041861700_r30","first-page":"1","article-title":"Discordance between fetal ultrasound and MRI to predict severity in congenital diaphragmatic hernia","volume-title":"Fetal Diagn Ther.","author":"Moody","year":"2025"},{"issue":"4","key":"2026053120041861700_r31","doi-asserted-by":"crossref","first-page":"1508","DOI":"10.3390\/jcm12041508","article-title":"Fetal lung volume appears to predict respiratory morbidity in congenital diaphragmatic hernia","volume":"12","author":"Cerbelle","year":"2023","journal-title":"J Clin Med."},{"issue":"6","key":"2026053120041861700_r32","doi-asserted-by":"crossref","first-page":"662","DOI":"10.1002\/uog.13223","article-title":"Fetal lung volume and quantification of liver herniation by magnetic resonance imaging in isolated congenital diaphragmatic hernia","volume":"43","author":"Ruano","year":"2014","journal-title":"Ultrasound Obstet Gynecol."},{"issue":"5","key":"2026053120041861700_r33","doi-asserted-by":"crossref","first-page":"688","DOI":"10.1016\/j.jpedsurg.2014.02.048","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":"2","key":"2026053120041861700_r34","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1016\/j.jpeds.2014.10.024","article-title":"Persistence of pulmonary hypertension by echocardiography predicts short-term outcomes in congenital diaphragmatic hernia","volume":"166","author":"Lusk","year":"2015","journal-title":"J Pediatr."},{"issue":"4","key":"2026053120041861700_r35","doi-asserted-by":"crossref","first-page":"703","DOI":"10.1016\/j.jpedsurg.2009.11.013","article-title":"Prenatal pulmonary hypertension index: novel prenatal predictor of severe postnatal pulmonary artery hypertension in antenatally diagnosed congenital diaphragmatic hernia","volume":"45","author":"Vuletin","year":"2010","journal-title":"J Pediatr Surg."},{"issue":"4","key":"2026053120041861700_r36","doi-asserted-by":"crossref","first-page":"606","DOI":"10.1016\/j.jpedsurg.2007.12.003","article-title":"Predicting perinatal outcome in isolated congenital diaphragmatic hernia using fetal pulmonary artery diameters","volume":"43","author":"Ruano","year":"2008","journal-title":"J Pediatr Surg."},{"key":"2026053120041861700_r37","doi-asserted-by":"crossref","first-page":"115821","DOI":"10.1016\/j.amjsurg.2024.115821","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":"3","key":"2026053120041861700_r38","doi-asserted-by":"crossref","first-page":"398","DOI":"10.1002\/pd.5880","article-title":"What should we tell parents? Congenital diaphragmatic hernia","volume":"42","author":"Russo","year":"2022","journal-title":"Prenat Diagn."},{"issue":"7","key":"2026053120041861700_r39","doi-asserted-by":"crossref","first-page":"805","DOI":"10.1038\/jp.2017.11","article-title":"Risk stratification for congenital diaphragmatic hernia by factors within 24\u2009h after birth","volume":"37","author":"Terui","year":"2017","journal-title":"J Perinatol."},{"issue":"5","key":"2026053120041861700_r40","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1038\/sj.jp.7211257","article-title":"SNAP-II predicts mortality among infants with congenital diaphragmatic hernia","volume":"25","author":"Skarsgard","year":"2005","journal-title":"J Perinatol."},{"issue":"7","key":"2026053120041861700_r41","doi-asserted-by":"crossref","first-page":"653","DOI":"10.1002\/pd.2571","article-title":"The making of fetal surgery","volume":"30","author":"Deprest","year":"2010","journal-title":"Prenat Diagn."},{"issue":"4","key":"2026053120041861700_r42","doi-asserted-by":"crossref","first-page":"637","DOI":"10.1007\/s00247-021-05153-1","article-title":"Prenatal lung volumes in congenital diaphragmatic hernia and their effect on postnatal outcomes","volume":"52","author":"Mehollin-Ray","year":"2022","journal-title":"Pediatr Radiol."},{"issue":"10","key":"2026053120041861700_r43","doi-asserted-by":"crossref","first-page":"1873","DOI":"10.1016\/j.jpedsurg.2011.06.007","article-title":"Prenatal risk stratification for isolated congenital diaphragmatic hernia: results of a Japanese multicenter study","volume":"46","author":"Usui","year":"2011","journal-title":"J Pediatr Surg."},{"issue":"1","key":"2026053120041861700_r44","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1055\/s-0039-1698768","article-title":"Novel risk score for fetuses with congenital diaphragmatic hernia based on ultrasound findings","volume":"30","author":"Terui","year":"2020","journal-title":"Eur J Pediatr Surg."},{"issue":"10","key":"2026053120041861700_r45","doi-asserted-by":"crossref","first-page":"1411","DOI":"10.1016\/S0022-3468(05)80338-0","article-title":"Correction of congenital diaphragmatic hernia in utero: VI. Hard-earned lessons","volume":"28","author":"Harrison","year":"1993","journal-title":"J Pediatr Surg."},{"issue":"2","key":"2026053120041861700_r46","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1016\/0022-3468(94)90328-X","article-title":"Experimental fetal tracheal ligation reverses the structural and physiological effects of pulmonary hypoplasia in congenital diaphragmatic hernia","volume":"29","author":"DiFiore","year":"1994","journal-title":"J Pediatr Surg."},{"issue":"20","key":"2026053120041861700_r47","doi-asserted-by":"crossref","first-page":"1916","DOI":"10.1056\/NEJMoa035005","article-title":"A randomized trial of fetal endoscopic tracheal occlusion for severe fetal congenital diaphragmatic hernia","volume":"349","author":"Harrison","year":"2003","journal-title":"N Engl J Med."},{"issue":"2","key":"2026053120041861700_r48","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1002\/uog.1711","article-title":"Fetoscopic tracheal occlusion (FETO) for severe congenital diaphragmatic hernia: evolution of a technique and preliminary results","volume":"24","author":"Deprest","year":"2004","journal-title":"Ultrasound Obstet Gynecol."},{"issue":"2","key":"2026053120041861700_r49","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1056\/NEJMoa2027030","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":"2026053120041861700_r50","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1056\/NEJMoa2026983","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":"2026053120041861700_r51","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1002\/pd.6091","article-title":"How should fetal surgery for congenital diaphragmatic hernia be implemented in the post-TOTAL trial era: a discussion","volume":"42","author":"Deprest","year":"2022","journal-title":"Prenat Diagn."},{"issue":"22","key":"2026053120041861700_r52","doi-asserted-by":"crossref","first-page":"2111","DOI":"10.1056\/NEJMc2115673","article-title":"Fetal surgery for severe left diaphragmatic hernia","volume":"385","author":"Stolar","year":"2021","journal-title":"N Engl J Med."},{"issue":"6","key":"2026053120041861700_r53","doi-asserted-by":"crossref","first-page":"632","DOI":"10.1159\/000546160","article-title":"Fetoscopic endoluminal tracheal occlusion versus expectant management for severe congenital diaphragmatic hernia at a single center","volume":"52","author":"Land","year":"2025","journal-title":"Fetal Diagn Ther."},{"issue":"6","key":"2026053120041861700_r54","doi-asserted-by":"crossref","first-page":"667","DOI":"10.1002\/uog.26164","article-title":"Fetal endoscopic tracheal occlusion for congenital diaphragmatic hernia: systematic review and meta-analysis","volume":"61","author":"Chen","year":"2023","journal-title":"Ultrasound Obstet Gynecol."},{"issue":"3","key":"2026053120041861700_r55","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1002\/pd.5988","article-title":"Impact of fetal endoscopic tracheal occlusion in fetuses with congenital diaphragmatic hernia and moderate lung hypoplasia","volume":"42","author":"Cruz-Mart\u00ednez","year":"2022","journal-title":"Prenat Diagn."},{"issue":"9","key":"2026053120041861700_r56","doi-asserted-by":"crossref","first-page":"1217","DOI":"10.1007\/s00383-022-05170-7","article-title":"Fetal endoscopic tracheal occlusion for moderate and severe congenital diaphragmatic hernia: a systematic review and meta-analysis of randomized controlled trials","volume":"38","author":"Li","year":"2022","journal-title":"Pediatr Surg Int."},{"key":"2026053120041861700_r57","article-title":"Fetoscopic endoluminal tracheal occlusion referral guidelines","author":"Hedrick"},{"key":"2026053120041861700_r58","article-title":"Referral guidelines for fetal endotracheal occlusion (FETO) for congenital diaphragmatic hernia (CDH)","author":"Texas Children\u2019s Hospital","year":"2025"},{"issue":"1","key":"2026053120041861700_r59","doi-asserted-by":"crossref","first-page":"78.e1","DOI":"10.1016\/j.ajog.2017.02.041","article-title":"Balloon removal after fetoscopic endoluminal tracheal occlusion for congenital diaphragmatic hernia","volume":"217","author":"Jim\u00e9nez","year":"2017","journal-title":"Am J Obstet Gynecol."},{"issue":"1","key":"2026053120041861700_r60","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1136\/archdischild-2023-325525","article-title":"Prevalence of symptomatic tracheal morbidities after fetoscopic endoluminal tracheal occlusion: a systematic review and meta-analysis","volume":"109","author":"Tho","year":"2023","journal-title":"Arch Dis Child Fetal Neonatal Ed."},{"issue":"8","key":"2026053120041861700_r61","doi-asserted-by":"crossref","first-page":"580","DOI":"10.1016\/S2352-4642(24)00109-3","article-title":"Tracheomalacia and tracheomegaly in infants and children with congenital diaphragmatic hernia managed with and without fetoscopic endoluminal tracheal occlusion (FETO): a multicentre, retrospective cohort study","volume":"8","author":"Basurto","year":"2024","journal-title":"Lancet Child Adolesc Health."},{"issue":"3","key":"2026053120041861700_r62","doi-asserted-by":"crossref","first-page":"440","DOI":"10.1097\/AOG.0000000000005491","article-title":"Fetoscopic endoluminal tracheal occlusion for severe, left-sided congenital diaphragmatic hernia: the North American Fetal Therapy Network Fetoscopic Endoluminal Tracheal Occlusion Consortium experience","volume":"143","author":"Bergh","year":"2024","journal-title":"Obstet Gynecol."},{"issue":"4","key":"2026053120041861700_r63","doi-asserted-by":"crossref","first-page":"808","DOI":"10.1016\/j.jamcollsurg.2013.12.047","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":"1","key":"2026053120041861700_r64","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1186\/s40748-017-0045-1","article-title":"Congenital Diaphragmatic hernia - a review","volume":"3","author":"Chandrasekharan","year":"2017","journal-title":"Matern Health Neonatol Perinatol."},{"issue":"3","key":"2026053120041861700_r65","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1053\/j.sempedsurg.2017.04.006","article-title":"ECMO in CDH: Is there a role?","volume":"26","author":"Kays","year":"2017","journal-title":"Semin Pediatr Surg."},{"issue":"4","key":"2026053120041861700_r66","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1159\/000320622","article-title":"Standardized postnatal management of infants with congenital diaphragmatic hernia in Europe: the CDH EURO Consortium consensus","volume":"98","author":"Reiss","year":"2010","journal-title":"Neonatology."},{"key":"2026053120041861700_r67","doi-asserted-by":"crossref","first-page":"336","DOI":"10.3389\/fped.2019.00336","article-title":"Extracorporeal membrane oxygenation in congenital diaphragmatic hernia","volume":"7","author":"Rafat","year":"2019","journal-title":"Front Pediatr."},{"issue":"1","key":"2026053120041861700_r68","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1159\/000444210","article-title":"Standardized postnatal management of infants with congenital diaphragmatic hernia in Europe: the CDH EURO Consortium consensus - 2015 update","volume":"110","author":"Snoek","year":"2016","journal-title":"Neonatology."},{"key":"2026053120041861700_r69","first-page":"162571","article-title":"Less is more: ECMO utilization and outcomes in congenital diaphragmatic hernia","author":"Kahan","year":"2025","journal-title":"J Pediatr Surg."},{"issue":"1","key":"2026053120041861700_r70","doi-asserted-by":"crossref","first-page":"60.e1","DOI":"10.1016\/j.ajog.2007.05.034","article-title":"Fetal lung volume after endoscopic tracheal occlusion in the prediction of postnatal outcome","volume":"198","author":"Peralta","year":"2008","journal-title":"Am J Obstet Gynecol."},{"issue":"6","key":"2026053120041861700_r71","doi-asserted-by":"crossref","first-page":"752","DOI":"10.1002\/uog.20216","article-title":"Fetal endoscopic tracheal occlusion reduces pulmonary hypertension in severe congenital diaphragmatic hernia","volume":"54","author":"Style","year":"2019","journal-title":"Ultrasound Obstet Gynecol."},{"issue":"3","key":"2026053120041861700_r72","doi-asserted-by":"crossref","first-page":"e000747","DOI":"10.1136\/wjps-2023-000747","article-title":"Surgical management of the diaphragmatic defect in congenital diaphragmatic hernia: a contemporary review","volume":"7","author":"Jank","year":"2024","journal-title":"World J Pediatr Surg."},{"issue":"4","key":"2026053120041861700_r73","doi-asserted-by":"crossref","first-page":"151441","DOI":"10.1016\/j.sempedsurg.2024.151441","article-title":"Surgical approaches to congenital diaphragmatic hernia","volume":"33","author":"King","year":"2024","journal-title":"Semin Pediatr Surg."},{"issue":"1","key":"2026053120041861700_r74","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1016\/0022-3468(95)90600-2","article-title":"Experience with abdominal wall closure for patients with congenital diaphragmatic hernia repaired on ECMO","volume":"30","author":"Schnitzer","year":"1995","journal-title":"J Pediatr Surg."},{"issue":"6","key":"2026053120041861700_r75","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1016\/j.siny.2014.09.007","article-title":"Novel non-surgical prenatal approaches to treating congenital diaphragmatic hernia","volume":"19","author":"Jeanty","year":"2014","journal-title":"Semin Fetal Neonatal Med."},{"issue":"2","key":"2026053120041861700_r76","first-page":"L423","article-title":"Vitamin A decreases the incidence and severity of nitrofen-induced congenital diaphragmatic hernia in rats","volume":"277","author":"Th\u00e9baud","year":"1999","journal-title":"Am J Physiol."},{"issue":"3","key":"2026053120041861700_r77","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1016\/0022-3468(95)90046-2","article-title":"Prenatal hormonal therapy improves pulmonary compliance in the nitrofen-induced CDH rat model","volume":"30","author":"Losty","year":"1995","journal-title":"J Pediatr Surg."},{"issue":"8","key":"2026053120041861700_r78","doi-asserted-by":"crossref","first-page":"1446","DOI":"10.1016\/j.jpedsurg.2006.04.022","article-title":"Effects of antioxidant vitamins on molecular regulators involved in lung hypoplasia induced by nitrofen","volume":"41","author":"Gonzalez-Reyes","year":"2006","journal-title":"J Pediatr Surg."},{"issue":"3","key":"2026053120041861700_r79","doi-asserted-by":"crossref","first-page":"1144","DOI":"10.1210\/en.2012-1786","article-title":"Pulmonary GLP-1 receptor increases at birth and exogenous GLP-1 receptor agonists augmented surfactant-protein levels in litters from normal and nitrofen-treated pregnant rats","volume":"154","author":"Roman\u00ed-P\u00e9rez","year":"2013","journal-title":"Endocrinology."},{"issue":"19","key":"2026053120041861700_r80","doi-asserted-by":"crossref","first-page":"2120","DOI":"10.1161\/CIRCULATIONAHA.108.845909","article-title":"Antenatal sildenafil treatment attenuates pulmonary hypertension in experimental congenital diaphragmatic hernia","volume":"123","author":"Luong","year":"2011","journal-title":"Circulation."},{"issue":"11","key":"2026053120041861700_r81","doi-asserted-by":"crossref","first-page":"L1159","DOI":"10.1152\/ajplung.00325.2010","article-title":"Antenatal imatinib treatment reduces pulmonary vascular remodeling in a rat model of congenital diaphragmatic hernia","volume":"302","author":"Chang","year":"2012","journal-title":"Am J Physiol Lung Cell Mol Physiol."},{"issue":"6","key":"2026053120041861700_r82","doi-asserted-by":"crossref","first-page":"1083","DOI":"10.1164\/ajrccm.164.6.2010115","article-title":"Restoring effects of vitamin A on surfactant synthesis in nitrofen-induced congenital diaphragmatic hernia in rats","volume":"164","author":"Th\u00e9baud","year":"2001","journal-title":"Am J Respir Crit Care Med."},{"issue":"2","key":"2026053120041861700_r83","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1016\/0022-3468(94)90348-4","article-title":"Combined antenatal thyrotropin-releasing hormone and low-dose glucocorticoid therapy improves the pulmonary biochemical immaturity in congenital diaphragmatic hernia","volume":"29","author":"Suen","year":"1994","journal-title":"J Pediatr Surg."},{"issue":"3","key":"2026053120041861700_r84","doi-asserted-by":"crossref","first-page":"350","DOI":"10.20517\/evcna.2025.25","article-title":"A new hope for pulmonary hypoplasia: amniotic fluid stem cell extracellular vesicles?","volume":"6","author":"Atukorala","year":"2025","journal-title":"Extracell Vesicles Circ Nucleic Acids."},{"key":"2026053120041861700_r85","doi-asserted-by":"crossref","first-page":"eaax5941","DOI":"10.1126\/scitranslmed.aax5941","article-title":"Fetal lung underdevelopment is rescued by administration of amniotic fluid stem cell extracellular vesicles in rodents","volume":"13","author":"Antounians","year":"2021","journal-title":"Sci Transl Med."},{"issue":"30","key":"2026053120041861700_r86","doi-asserted-by":"crossref","first-page":"eadn5405","DOI":"10.1126\/sciadv.adn5405","article-title":"Fetal hypoplastic lungs have multilineage inflammation that is reversed by amniotic fluid stem cell extracellular vesicle treatment","volume":"10","author":"Antounians","year":"2024","journal-title":"Sci Adv."},{"issue":"9","key":"2026053120041861700_r87","doi-asserted-by":"crossref","first-page":"1771","DOI":"10.1016\/j.jpedsurg.2024.02.029","article-title":"Antenatal administration of extracellular vesicles derived from amniotic fluid stem cells improves lung function in neonatal rats with congenital diaphragmatic hernia","volume":"59","author":"Figueira","year":"2024","journal-title":"J Pediatr Surg."},{"issue":"2","key":"2026053120041861700_r88","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1016\/j.jpedsurg.2019.10.033","article-title":"Congenital diaphragmatic hernia as a potential target for transamniotic stem cell therapy","volume":"55","author":"Chalphin","year":"2020","journal-title":"J Pediatr Surg."},{"issue":"5","key":"2026053120041861700_r89","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1159\/000515277","article-title":"Transamniotic stem cell therapy for experimental congenital diaphragmatic hernia: structural, transcriptional, and cell kinetics analyses in the nitrofen model","volume":"48","author":"Chalphin","year":"2021","journal-title":"Fetal Diagn Ther."},{"issue":"3","key":"2026053120041861700_r90","doi-asserted-by":"crossref","first-page":"151731","DOI":"10.1016\/j.semperi.2023.151731","article-title":"Barriers in translating stem cell therapies for neonatal diseases","volume":"47","author":"Damianos","year":"2023","journal-title":"Semin Perinatol."},{"issue":"15","key":"2026053120041861700_r91","doi-asserted-by":"crossref","first-page":"7472","DOI":"10.3390\/app12157472","article-title":"Extracellular vesicles for regenerative medicine applications","volume":"12","author":"Crum","year":"2022","journal-title":"Appl Sci (Basel)."},{"key":"2026053120041861700_r92","doi-asserted-by":"crossref","first-page":"1639439","DOI":"10.3389\/fbioe.2025.1639439","article-title":"From bench to bedside: translating mesenchymal stem cell therapies through preclinical and clinical evidence","volume":"13","author":"Patel","year":"2025","journal-title":"Front Bioeng Biotechnol."},{"issue":"1","key":"2026053120041861700_r93","doi-asserted-by":"crossref","first-page":"152","DOI":"10.3390\/biom10010152","article-title":"Retinoic acid: a key regulator of lung development","volume":"10","author":"Fernandes-Silva","year":"2020","journal-title":"Biomolecules."},{"issue":"6","key":"2026053120041861700_r94","doi-asserted-by":"crossref","first-page":"1415","DOI":"10.1038\/s41390-024-03086-7","article-title":"Disruptions in retinoic acid signaling pathway contribute to abnormal lung development in congenital diaphragmatic hernia: a therapeutic potential for retinoids to attenuate pulmonary hypoplasia","volume":"95","author":"Friedmacher","year":"2024","journal-title":"Pediatr Res."},{"issue":"2","key":"2026053120041861700_r95","doi-asserted-by":"crossref","first-page":"L147","DOI":"10.1152\/ajplung.00108.2014","article-title":"Metabolic disturbances of the vitamin A pathway in human diaphragmatic hernia","volume":"308","author":"Coste","year":"2015","journal-title":"Am J Physiol Lung Cell Mol Physiol."},{"issue":"3","key":"2026053120041861700_r96","doi-asserted-by":"crossref","first-page":"500","DOI":"10.1016\/j.jpedsurg.2007.10.030","article-title":"Prenatal treatment with retinoic acid promotes pulmonary alveologenesis in the nitrofen model of congenital diaphragmatic hernia","volume":"43","author":"Montedonico","year":"2008","journal-title":"J Pediatr Surg."},{"issue":"7","key":"2026053120041861700_r97","doi-asserted-by":"crossref","first-page":"6656","DOI":"10.3390\/ijms24076656","article-title":"Role of microRNAs in congenital diaphragmatic hernia-associated pulmonary hypertension","volume":"24","author":"Pugnaloni","year":"2023","journal-title":"Int J Mol Sci."},{"issue":"6","key":"2026053120041861700_r98","doi-asserted-by":"crossref","first-page":"1130","DOI":"10.1097\/SLA.0000000000001054","article-title":"Unique tracheal fluid microRNA signature predicts response to FETO in patients with congenital diaphragmatic hernia","volume":"262","author":"Pereira-Terra","year":"2015","journal-title":"Ann Surg."},{"issue":"5","key":"2026053120041861700_r99","doi-asserted-by":"crossref","first-page":"979","DOI":"10.1097\/SLA.0000000000002595","article-title":"Prenatal microRNA miR-200b therapy improves nitrofen-induced pulmonary hypoplasia associated with congenital diaphragmatic hernia","volume":"269","author":"Khoshgoo","year":"2019","journal-title":"Ann Surg."},{"key":"2026053120041861700_r100","doi-asserted-by":"crossref","first-page":"594","DOI":"10.1016\/j.omtn.2023.04.018","article-title":"In utero delivery of miRNA induces epigenetic alterations and corrects pulmonary pathology in congenital diaphragmatic hernia","volume":"32","author":"Ullrich","year":"2023","journal-title":"Mol Ther Nucleic Acids."},{"issue":"12","key":"2026053120041861700_r101","doi-asserted-by":"crossref","first-page":"101535","DOI":"10.1016\/j.ajogmf.2024.101535","article-title":"microRNAs in congenital diaphragmatic hernia: insights into prenatal and perinatal biomarkers and altered molecular pathways","volume":"6","author":"Bardill","year":"2024","journal-title":"Am J Obstet Gynecol MFM."},{"issue":"2","key":"2026053120041861700_r102","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1007\/s40778-024-00235-w","article-title":"The technical and ethical framework of fetal therapy: past and current advances","volume":"10","author":"Lynn","year":"2024","journal-title":"Curr Stem Cell Rep."},{"issue":"41","key":"2026053120041861700_r103","first-page":"e2306134","article-title":"Non-viral RNA delivery during pregnancy: opportunities and challenges","volume":"20","author":"Chaudhary","year":"2024","journal-title":"Small."},{"issue":"4","key":"2026053120041861700_r104","doi-asserted-by":"crossref","first-page":"904","DOI":"10.1097\/GRF.0000000000000662","article-title":"Prenatal gene therapy for metabolic disorders","volume":"64","author":"Coons","year":"2021","journal-title":"Clin Obstet Gynecol."}],"container-title":["NeoReviews"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/neoreviews\/article-pdf\/27\/6\/e369\/1935639\/neoreviews.022026cmerev00050.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/neoreviews\/article-pdf\/27\/6\/e369\/1935639\/neoreviews.022026cmerev00050.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T00:04:32Z","timestamp":1780272272000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/neoreviews\/article\/27\/6\/e369\/207802\/Risk-Stratification-and-Fetal-Therapies-for"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,1]]},"references-count":104,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2026,6,1]]},"published-print":{"date-parts":[[2026,6,1]]}},"URL":"https:\/\/doi.org\/10.1542\/neo.27-6-021","relation":{},"ISSN":["1526-9906"],"issn-type":[{"value":"1526-9906","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,1]]}}}