Unsolved Problems in Congenital Diaphragmatic Hernia

Congenital diaphragmatic hernia (CDH) remains one of the major challenges for neonatologists and pediatric surgeons with a worldwide mortality of around 25%. Over the last decade, different proposals of standardized postnatal therapy have been published, resulting in universal accepted criteria for different treatment modalities and significant improvement of therapy results. However, the level of evidence of the different treatment modalities remains low due to the absence of properly conducted randomized controlled trials. In the near future, a combination of prenatal intervention studies with well-documented primary endpoints is essential to enhance survival together with new studies aiming at the prevention of ongoing damage to the developing lungs in the postnatal phase of life.

Taking the internationally accepted guidelines both from the CDH EURO Consortium and the Canadian CDH Study Group different aspects starting in the fetal period of life throughout long term follow-up will be discussed at the background of a short summary of the contemporary knowledge from the literature and personal experience of the different contributors. The main aim is to identify for each aspect unsolved problems as guidance for future studies and international collaboration (see list of contributors). Integration of different specialties and new ideas of future studies will be highlighted by interdisciplinary teams of authors guided by a senior clinician/scientist.

Article contributions will address specific aspects of normal and abnormal development, and the effect of different treatment modalities with a focus on unsolved problems in CDH. The articles should include only the literature necessary to clearly identify the ongoing problem that should be solved to increase survival and/or decrease morbidity in individual patients.