1. Antenatal management of congenital diaphragmatic hernia today and tomorrow
- Author
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Paolo De Coppi, Stuart B. Hooper, Jaan Toelen, Francesca Russo, Namesh Khoshgoo, Philip DeKoninck, Johannes van der Merwe, Lennart Van der Veeken, Richard Keijzer, Dyuti Sharma, Marie P Eastwood, Tram Mai Nguyen, Karel Allegaert, Jan Deprest, and David Basurto
- Subjects
0301 basic medicine ,medicine.medical_specialty ,Sildenafil ,Hypertension, Pulmonary ,medicine.medical_treatment ,Diaphragmatic breathing ,030105 genetics & heredity ,Sildenafil Citrate ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Pregnancy ,medicine ,Humans ,Fetal Therapies ,Fetus ,030219 obstetrics & reproductive medicine ,Lung ,Fetal surgery ,business.industry ,Fetoscopy ,Congenital diaphragmatic hernia ,Phosphodiesterase 5 Inhibitors ,Prognosis ,medicine.disease ,Surgery ,Clinical trial ,medicine.anatomical_structure ,chemistry ,Pediatrics, Perinatology and Child Health ,Female ,Hernias, Diaphragmatic, Congenital ,business - Abstract
Congenital diaphragmatic hernia is rare birth defect, which can be easily corrected after birth. The main problem is that herniation of viscera during fetal development impairs lung development, leading to a 30 % mortality and significant morbidity. In isolated cases the outcome can be accurately predicted prenatally by medical imaging. Cases with a poor prognosis can be treated before birth; clinically this is by fetoscopic endoluminal tracheal occlusion. Obstruction of the airways triggers lung growth. This procedure and is currently being evaluated in a global clinical trial for left sided cases; right sided cases with poor prognosis are offered the procedure clinically. The search for more potent and less invasive therapies continues. Prenatal transplacental sildenafil administration will in due course be tried clinically, with the aim to reduce the occurrence of persistent pulmonary hypertension, either alone or in combination with fetal surgery. Other medical approaches are in an earlier translational phase. ispartof: Minerva Pediatrica vol:70 issue:3 pages:270-280 ispartof: location:ITALY, Messina status: published
- Published
- 2018