ABSTRACT
Congenital diaphragmatic hernia (CDH) occurs in up to 1 in 2500 live births. It is a field defect, involving the lungs, foregut, and chest wall, resulting from failure of the diaphragm to separate the pleuroperitoneal canal into the thorax and abdomen before the midgut returns through the umbilicus. The majority of infants with CDH are diagnosed antenatally. Ultrasound may show bowel and/or liver in the chest, the heart and stomach in the same plane, or mediastinal shift. Fetal magnetic resonance imaging has also become a useful adjunct to differentiate CDH from lung bud anomalies. The airway should be controlled with orotracheal intubation. Single lung ventilation is unnecessary. Intravenous anesthesia is administered as needed and complemented by muscle paralysis and narcotics. While a thoracotomy may be used for CDH repair, it is generally avoided due to its morbidity. Thoracoscopic repair is also an option in stable infants.
