Congenital diaphragmatic hernia. II. Can we get away from pulmonary hypoplasia?

Despite major insights into the pathogenesis and pathophysiology of congeni tal diaphragmatic heroin, and despite the availability of an antenatal diag nosis and continuous progress in neonatal intensive care, little improvemen t has been obtained in the prognosis of this malformation. Thus obstetricia ns, neonatologists and pediatric surgeons are still facing a several dilemm a: dilemma before birth to predict the prognosis, i.e., to evaluate the sev erity of the associated pulmonary hypoplasia in order to decide whether or not to interrupt pregnancy; dilemma after birth in case of severe respirato ry failure to decide how far to go in life support. Based on a review of th e literature and their ,own experience, the authors attempt to recapitulate the perinatal management and outcome of this severe malformation. (C) 1999 Elsevier, Paris.