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Congenital diaphragmatic hernia in the neonate

INTRODUCTION

Congenital diaphragmatic hernia (CDH) is a developmental defect of the diaphragm that allows abdominal viscera to herniate into the chest. The volume of herniated contents may be small or large enough to contain most of the gut, spleen, or liver. Because herniation occurs during a critical period of lung development when bronchial and pulmonary artery branching occurs, lung compression by the herniated bowel results in pulmonary hypoplasia. With increasing severity of lung compression, there is a corresponding decrease in the bronchial branching, resulting in a reduction of generations of bronchi and lung tissue. Pulmonary hypoplasia is most severe on the ipsilateral side but may also occur on the contralateral side if the mediastinum shifts and compresses the contralateral lung. In addition, arterial branching is reduced and there is muscular hyperplasia of the pulmonary arterial tree [1]. Biochemical analysis also indicates there is a secondary surfactant deficiency [2-4]. (See "Congenital diaphragmatic hernia: Prenatal diagnosis and management".)

CDH is estimated to occur in 1 out of 2200 births. Affected neonates usually present in the first few hours of life with respiratory distress that may be mild or so severe as to be incompatible with life. With the advent of antenatal diagnosis and improvement of neonatal care, survival has improved, but there still remains significant risk of death and complications in infants with CDH.

The clinical manifestations, diagnosis, and management of the neonate with CDH will be reviewed here. The pathogenesis, anatomy, and the prenatal diagnosis and management of CDH are discussed separately. (See "Congenital diaphragmatic hernia: Prenatal diagnosis and management".)

CLINICAL MANIFESTATIONS

Infants with congenital diaphragmatic hernia (CDH) most often develop respiratory distress in the first few hours or days of life. The spectrum of presentation can vary from acute, severe respiratory distress at birth, which is common, to minimal or no symptoms, which is observed in a much smaller group of patients.

Physical examination will reveal a barrel-shaped chest, a scaphoid appearing abdomen because of loss of the abdominal contents into the chest, and absence of breath sounds on the ipsilateral side. In most patients with CDH (because the lesion is on the left side), the heartbeat is displaced to the right because of a shift in the mediastinum.

                              

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Literature review current through: Mar 2014. | This topic last updated: Jan 21, 2014.
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References
Top
  1. Bloss RS, Aranda JV, Beardmore HE. Congenital diaphragmatic hernia: pathophysiology and pharmacologic support. Surgery 1981; 89:518.
  2. Lotze A, Knight GR, Anderson KD, et al. Surfactant (beractant) therapy for infants with congenital diaphragmatic hernia on ECMO: evidence of persistent surfactant deficiency. J Pediatr Surg 1994; 29:407.
  3. Wilcox DT, Glick PL, Karamanoukian HL, Holm BA. Pathophysiology of congenital diaphragmatic hernia. IX: Correlation of surfactant maturation with fetal cortisol and triiodothyronine concentration. J Pediatr Surg 1994; 29:825.
  4. Wilcox DT, Glick PL, Karamanoukian HL, et al. Pathophysiology of congenital diaphragmatic hernia. XII: Amniotic fluid lecithin/sphingomyelin ratio and phosphatidylglycerol concentrations do not predict surfactant status in congenital diaphragmatic hernia. J Pediatr Surg 1995; 30:410.
  5. Hedrick HL, Crombleholme TM, Flake AW, et al. Right congenital diaphragmatic hernia: Prenatal assessment and outcome. J Pediatr Surg 2004; 39:319.
  6. Kamath BD, Fashaw L, Kinsella JP. Adrenal insufficiency in newborns with congenital diaphragmatic hernia. J Pediatr 2010; 156:495.
  7. Sakurai M, Donnelly LF, Klosterman LA, Strife JL. Congenital diaphragmatic hernia in neonates: variations in umbilical catheter and enteric tube position. Radiology 2000; 216:112.
  8. Ladd W, Gross R. Abdominal Surgery of Infancy and Childhood, W.B. Saunders, Philadelphia 1941.
  9. GROSS RE. Congenital hernia of the diaphragm. Am J Dis Child 1946; 71:579.
  10. Wung JT, Sahni R, Moffitt ST, et al. Congenital diaphragmatic hernia: survival treated with very delayed surgery, spontaneous respiration, and no chest tube. J Pediatr Surg 1995; 30:406.
  11. Frenckner B, Ehrén H, Granholm T, et al. Improved results in patients who have congenital diaphragmatic hernia using preoperative stabilization, extracorporeal membrane oxygenation, and delayed surgery. J Pediatr Surg 1997; 32:1185.
  12. Boloker J, Bateman DA, Wung JT, Stolar CJ. Congenital diaphragmatic hernia in 120 infants treated consecutively with permissive hypercapnea/spontaneous respiration/elective repair. J Pediatr Surg 2002; 37:357.
  13. Reickert CA, Hirschl RB, Schumacher R, et al. Effect of very delayed repair of congenital diaphragmatic hernia on survival and extracorporeal life support use. Surgery 1996; 120:766.
  14. Kays DW, Langham MR Jr, Ledbetter DJ, Talbert JL. Detrimental effects of standard medical therapy in congenital diaphragmatic hernia. Ann Surg 1999; 230:340.
  15. Downard CD, Jaksic T, Garza JJ, et al. Analysis of an improved survival rate for congenital diaphragmatic hernia. J Pediatr Surg 2003; 38:729.
  16. Logan JW, Rice HE, Goldberg RN, Cotten CM. Congenital diaphragmatic hernia: a systematic review and summary of best-evidence practice strategies. J Perinatol 2007; 27:535.
  17. Glick PL, Leach CL, Besner GE, et al. Pathophysiology of congenital diaphragmatic hernia. III: Exogenous surfactant therapy for the high-risk neonate with CDH. J Pediatr Surg 1992; 27:866.
  18. Van Meurs K, Congenital Diaphragmatic Hernia Study Group. Is surfactant therapy beneficial in the treatment of the term newborn infant with congenital diaphragmatic hernia? J Pediatr 2004; 145:312.
  19. Wilson JM, Lund DP, Lillehei CW, Vacanti JP. Congenital diaphragmatic hernia--a tale of two cities: the Boston experience. J Pediatr Surg 1997; 32:401.
  20. Kolobow T, Moretti MP, Fumagalli R, et al. Severe impairment in lung function induced by high peak airway pressure during mechanical ventilation. An experimental study. Am Rev Respir Dis 1987; 135:312.
  21. Dreyfuss D, Soler P, Basset G, Saumon G. High inflation pressure pulmonary edema. Respective effects of high airway pressure, high tidal volume, and positive end-expiratory pressure. Am Rev Respir Dis 1988; 137:1159.
  22. Drummond WH, Gregory GA, Heymann MA, Phibbs RA. The independent effects of hyperventilation, tolazoline, and dopamine on infants with persistent pulmonary hypertension. J Pediatr 1981; 98:603.
  23. Reynolds M, Luck SR, Lappen R. The "critical" neonate with diaphragmatic hernia: a 21-year perspective. J Pediatr Surg 1984; 19:364.
  24. Chiu PP, Sauer C, Mihailovic A, et al. The price of success in the management of congenital diaphragmatic hernia: is improved survival accompanied by an increase in long-term morbidity? J Pediatr Surg 2006; 41:888.
  25. Datin-Dorriere V, Walter-Nicolet E, Rousseau V, et al. Experience in the management of eighty-two newborns with congenital diaphragmatic hernia treated with high-frequency oscillatory ventilation and delayed surgery without the use of extracorporeal membrane oxygenation. J Intensive Care Med 2008; 23:128.
  26. Reyes C, Chang LK, Waffarn F, et al. Delayed repair of congenital diaphragmatic hernia with early high-frequency oscillatory ventilation during preoperative stabilization. J Pediatr Surg 1998; 33:1010.
  27. Somaschini M, Locatelli G, Salvoni L, et al. Impact of new treatments for respiratory failure on outcome of infants with congenital diaphragmatic hernia. Eur J Pediatr 1999; 158:780.
  28. Migliazza L, Bellan C, Alberti D, et al. Retrospective study of 111 cases of congenital diaphragmatic hernia treated with early high-frequency oscillatory ventilation and presurgical stabilization. J Pediatr Surg 2007; 42:1526.
  29. Cohen MS, Rychik J, Bush DM, et al. Influence of congenital heart disease on survival in children with congenital diaphragmatic hernia. J Pediatr 2002; 141:25.
  30. Graziano JN, Congenital Diaphragmatic Hernia Study Group. Cardiac anomalies in patients with congenital diaphragmatic hernia and their prognosis: a report from the Congenital Diaphragmatic Hernia Study Group. J Pediatr Surg 2005; 40:1045.
  31. Gray BW, Fifer CG, Hirsch JC, et al. Contemporary outcomes in infants with congenital heart disease and bochdalek diaphragmatic hernia. Ann Thorac Surg 2013; 95:929.
  32. Dyamenahalli U, Morris M, Rycus P, et al. Short-term outcome of neonates with congenital heart disease and diaphragmatic hernia treated with extracorporeal membrane oxygenation. Ann Thorac Surg 2013; 95:1373.
  33. German JC, Gazzaniga AB, Amlie R, et al. Management of pulmonary insufficiency in diaphragmatic hernia using extracorporeal circulation with a membrane oxygenator (ECMO). J Pediatr Surg 1977; 12:905.
  34. Van Meurs KP, Newman KD, Anderson KD, Short BL. Effect of extracorporeal membrane oxygenation on survival of infants with congenital diaphragmatic hernia. J Pediatr 1990; 117:954.
  35. Langham MR Jr, Krummel TM, Bartlett RH, et al. Mortality with extracorporeal membrane oxygenation following repair of congenital diaphragmatic hernia in 93 infants. J Pediatr Surg 1987; 22:1150.
  36. Bailey PV, Connors RH, Tracy TF Jr, et al. A critical analysis of extracorporeal membrane oxygenation for congenital diaphragmatic hernia. Surgery 1989; 106:611.
  37. Rothenbach P, Lange P, Powell D. The use of extracorporeal membrane oxygenation in infants with congenital diaphragmatic hernia. Semin Perinatol 2005; 29:40.
  38. Conrad SA, Rycus PT, Dalton H. Extracorporeal Life Support Registry Report 2004. ASAIO J 2005; 51:4.
  39. Schumacher RE, Baumgart S. Extracorporeal membrane oxygenation 2001. The odyssey continues. Clin Perinatol 2001; 28:629.
  40. Delius R, Anderson H 3rd, Schumacher R, et al. Venovenous compares favorably with venoarterial access for extracorporeal membrane oxygenation in neonatal respiratory failure. J Thorac Cardiovasc Surg 1993; 106:329.
  41. Heiss KF, Clark RH, Cornish JD, et al. Preferential use of venovenous extracorporeal membrane oxygenation for congenital diaphragmatic hernia. J Pediatr Surg 1995; 30:416.
  42. Kugelman A, Gangitano E, Pincros J, et al. Venovenous versus venoarterial extracorporeal membrane oxygenation in congenital diaphragmatic hernia. J Pediatr Surg 2003; 38:1131.
  43. Dimmitt RA, Moss RL, Rhine WD, et al. Venoarterial versus venovenous extracorporeal membrane oxygenation in congenital diaphragmatic hernia: the Extracorporeal Life Support Organization Registry, 1990-1999. J Pediatr Surg 2001; 36:1199.
  44. Guner YS, Khemani RG, Qureshi FG, et al. Outcome analysis of neonates with congenital diaphragmatic hernia treated with venovenous vs venoarterial extracorporeal membrane oxygenation. J Pediatr Surg 2009; 44:1691.
  45. Hazebroek FW, Tibboel D, Bos AP, et al. Congenital diaphragmatic hernia: impact of preoperative stabilization. A prospective pilot study in 13 patients. J Pediatr Surg 1988; 23:1139.
  46. Goh DW, Drake DP, Brereton RJ, et al. Delayed surgery for congenital diaphragmatic hernia. Br J Surg 1992; 79:644.
  47. Langer JC, Filler RM, Bohn DJ, et al. Timing of surgery for congenital diaphragmatic hernia: is emergency operation necessary? J Pediatr Surg 1988; 23:731.
  48. Nio M, Haase G, Kennaugh J, et al. A prospective randomized trial of delayed versus immediate repair of congenital diaphragmatic hernia. J Pediatr Surg 1994; 29:618.
  49. Downard CD, Wilson JM. Current therapy of infants with congenital diaphragmatic hernia. Semin Neonatol 2003; 8:215.
  50. Lally KP. Extracorporeal membrane oxygenation in patients with congenital diaphragmatic hernia. Semin Pediatr Surg 1996; 5:249.
  51. Ryan CA, Perreault T, Johnston-Hodgson A, Finer NN. Extracorporeal membrane oxygenation in infants with congenital diaphragmatic hernia and cardiac malformations. J Pediatr Surg 1994; 29:878.
  52. Breaux CW Jr, Rouse TM, Cain WS, Georgeson KE. Congenital diaphragmatic hernia in an era of delayed repair after medical and/or extracorporeal membrane oxygenation stabilization: a prognostic and management classification. J Pediatr Surg 1992; 27:1192.
  53. Dillon PW, Cilley RE, Mauger D, et al. The relationship of pulmonary artery pressure and survival in congenital diaphragmatic hernia. J Pediatr Surg 2004; 39:307.
  54. Seetharamaiah R, Younger JG, Bartlett RH, et al. Factors associated with survival in infants with congenital diaphragmatic hernia requiring extracorporeal membrane oxygenation: a report from the Congenital Diaphragmatic Hernia Study Group. J Pediatr Surg 2009; 44:1315.
  55. Payne NR, Wright G, Kriesmer PJ, et al. Recurrent pulmonary arterial hypertension following neonatal treatment with extracorporeal membrane oxygenation. Crit Care Med 1991; 19:1210.
  56. Lally KP, Breaux CW Jr. A second course of extracorporeal membrane oxygenation in the neonate--is there a benefit? Surgery 1995; 117:175.
  57. Tsai J, Sulkowski J, Adzick NS, et al. Patch repair for congenital diaphragmatic hernia: is it really a problem? J Pediatr Surg 2012; 47:637.
  58. Lally KP, Cheu HW, Vazquez WD. Prosthetic diaphragm reconstruction in the growing animal. J Pediatr Surg 1993; 28:45.
  59. Schnitzer JJ, Kikiros CS, Short BL, et al. Experience with abdominal wall closure for patients with congenital diaphragmatic hernia repaired on ECMO. J Pediatr Surg 1995; 30:19.
  60. Brant-Zawadzki PB, Fenton SJ, Nichol PF, et al. The split abdominal wall muscle flap repair for large congenital diaphragmatic hernias on extracorporeal membrane oxygenation. J Pediatr Surg 2007; 42:1047.
  61. Rowe MI, Uribe FL. Diaphragmatic hernia in the newborn infant: blood gas and pH considerations. Surgery 1971; 70:758.
  62. Greenholz SK. Congenital diaphragmatic hernia: an overview. Semin Pediatr Surg 1996; 5:216.
  63. Dassinger MS, Copeland DR, Gossett J, et al. Early repair of congenital diaphragmatic hernia on extracorporeal membrane oxygenation. J Pediatr Surg 2010; 45:693.
  64. Lally KP, Paranka MS, Roden J, et al. Congenital diaphragmatic hernia. Stabilization and repair on ECMO. Ann Surg 1992; 216:569.
  65. Vazquez WD, Cheu HW. Hemorrhagic complications and repair of congenital diaphragmatic hernias: does timing of the repair make a difference? Data from the Extracorporeal Life Support Organization. J Pediatr Surg 1994; 29:1002.
  66. Wilson JM, Bower LK, Lund DP. Evolution of the technique of congenital diaphragmatic hernia repair on ECMO. J Pediatr Surg 1994; 29:1109.
  67. Cullen ML. Congenital diaphragmatic hernia: operative considerations. Semin Pediatr Surg 1996; 5:243.
  68. Sigalet DL, Tierney A, Adolph V, et al. Timing of repair of congenital diaphragmatic hernia requiring extracorporeal membrane oxygenation support. J Pediatr Surg 1995; 30:1183.
  69. Iocono JA, Cilley RE, Mauger DT, et al. Postnatal pulmonary hypertension after repair of congenital diaphragmatic hernia: predicting risk and outcome. J Pediatr Surg 1999; 34:349.
  70. Jancelewicz T, Chiang M, Oliveira C, Chiu PP. Late surgical outcomes among congenital diaphragmatic hernia (CDH) patients: why long-term follow-up with surgeons is recommended. J Pediatr Surg 2013; 48:935.
  71. Reid IS, Hutcherson RJ. Long-term follow-up of patients with congenital diaphragmatic hernia. J Pediatr Surg 1976; 11:939.
  72. Wohl ME, Griscom NT, Strieder DJ, et al. The lung following repair of congenital diaphragmatic hernia. J Pediatr 1977; 90:405.
  73. Falconer AR, Brown RA, Helms P, et al. Pulmonary sequelae in survivors of congenital diaphragmatic hernia. Thorax 1990; 45:126.
  74. Freyschuss U, Lännergren K, Frenckner B. Lung function after repair of congenital diaphragmatic hernia. Acta Paediatr Scand 1984; 73:589.
  75. Peetsold MG, Vonk-Noordegraaf A, Heij HH, Gemke RJ. Pulmonary function and exercise testing in adult survivors of congenital diaphragmatic hernia. Pediatr Pulmonol 2007; 42:325.
  76. Nagaya M, Akatsuka H, Kato J, et al. Development in lung function of the affected side after repair of congenital diaphragmatic hernia. J Pediatr Surg 1996; 31:349.
  77. Nagaya M, Kato J, Niimi N, et al. Analysis of patients with congenital diaphragmatic hernia requiring pre-operative extracorporeal membrane oxygenation (ECMO). Pediatr Surg Int 1998; 14:25.
  78. Hamutcu R, Nield TA, Garg M, et al. Long-term pulmonary sequelae in children who were treated with extracorporeal membrane oxygenation for neonatal respiratory failure. Pediatrics 2004; 114:1292.
  79. Bernbaum J, Schwartz IP, Gerdes M, et al. Survivors of extracorporeal membrane oxygenation at 1 year of age: the relationship of primary diagnosis with health and neurodevelopmental sequelae. Pediatrics 1995; 96:907.
  80. Van Meurs KP, Robbins ST, Reed VL, et al. Congenital diaphragmatic hernia: long-term outcome in neonates treated with extracorporeal membrane oxygenation. J Pediatr 1993; 122:893.
  81. D'Agostino JA, Bernbaum JC, Gerdes M, et al. Outcome for infants with congenital diaphragmatic hernia requiring extracorporeal membrane oxygenation: the first year. J Pediatr Surg 1995; 30:10.
  82. Koumbourlis AC, Wung JT, Stolar CJ. Lung function in infants after repair of congenital diaphragmatic hernia. J Pediatr Surg 2006; 41:1716.
  83. Trachsel D, Selvadurai H, Bohn D, et al. Long-term pulmonary morbidity in survivors of congenital diaphragmatic hernia. Pediatr Pulmonol 2005; 39:433.
  84. Cortes RA, Keller RL, Townsend T, et al. Survival of severe congenital diaphragmatic hernia has morbid consequences. J Pediatr Surg 2005; 40:36.
  85. Muratore CS, Kharasch V, Lund DP, et al. Pulmonary morbidity in 100 survivors of congenital diaphragmatic hernia monitored in a multidisciplinary clinic. J Pediatr Surg 2001; 36:133.
  86. Wynn J, Krishnan U, Aspelund G, et al. Outcomes of congenital diaphragmatic hernia in the modern era of management. J Pediatr 2013; 163:114.
  87. Trachsel D, Selvadurai H, Adatia I, et al. Resting and exercise cardiorespiratory function in survivors of congenital diaphragmatic hernia. Pediatr Pulmonol 2006; 41:522.
  88. Grethel E, Cortes R, Wagner A, et al. Prosthetic patches for congenital diaphragmatic hernia repair: surgisis versus gore-tex, American Pediatric Surgical Association, Phoenix, AZ 2005.
  89. Rais-Bahrami K, Robbins ST, Reed VL, et al. Congenital diaphragmatic hernia. Outcome of preoperative extracorporeal membrane oxygenation. Clin Pediatr (Phila) 1995; 34:471.
  90. Atkinson JB, Ford EG, Humphries B, et al. The impact of extracorporeal membrane support in the treatment of congenital diaphragmatic hernia. J Pediatr Surg 1991; 26:791.
  91. Jancelewicz T, Vu LT, Keller RL, et al. Long-term surgical outcomes in congenital diaphragmatic hernia: observations from a single institution. J Pediatr Surg 2010; 45:155.
  92. Riehle KJ, Magnuson DK, Waldhausen JH. Low recurrence rate after Gore-Tex/Marlex composite patch repair for posterolateral congenital diaphragmatic hernia. J Pediatr Surg 2007; 42:1841.
  93. Jawaid WB, Qasem E, Jones MO, et al. Outcomes following prosthetic patch repair in newborns with congenital diaphragmatic hernia. Br J Surg 2013; 100:1833.
  94. Lund DP, Mitchell J, Kharasch V, et al. Congenital diaphragmatic hernia: the hidden morbidity. J Pediatr Surg 1994; 29:258.
  95. Reickert C, Hirschl R. Congenital diaphragmatic hernia. In: Pediatric Surgery and Urology: Long Term Outcomes, Stringer MD, Oldham KT, Mouriquand PDE, Howard RH (Eds), W. B. Saunders, London 1998. p.131.
  96. Stolar CJ, Levy JP, Dillon PW, et al. Anatomic and functional abnormalities of the esophagus in infants surviving congenital diaphragmatic hernia. Am J Surg 1990; 159:204.
  97. Koot VC, Bergmeijer JH, Bos AP, Molenaar JC. Incidence and management of gastroesophageal reflux after repair of congenital diaphragmatic hernia. J Pediatr Surg 1993; 28:48.
  98. Kieffer J, Sapin E, Berg A, et al. Gastroesophageal reflux after repair of congenital diaphragmatic hernia. J Pediatr Surg 1995; 30:1330.
  99. Diamond IR, Mah K, Kim PC, et al. Predicting the need for fundoplication at the time of congenital diaphragmatic hernia repair. J Pediatr Surg 2007; 42:1066.
  100. Su W, Berry M, Puligandla PS, et al. Predictors of gastroesophageal reflux in neonates with congenital diaphragmatic hernia. J Pediatr Surg 2007; 42:1639.
  101. Koivusalo AI, Pakarinen MP, Lindahl HG, Rintala RJ. The cumulative incidence of significant gastroesophageal reflux in patients with congenital diaphragmatic hernia-a systematic clinical, pH-metric, and endoscopic follow-up study. J Pediatr Surg 2008; 43:279.
  102. Peetsold MG, Kneepkens CM, Heij HA, et al. Congenital diaphragmatic hernia: long-term risk of gastroesophageal reflux disease. J Pediatr Gastroenterol Nutr 2010; 51:448.
  103. Vanamo K. A 45-year perspective of congenital diaphragmatic hernia. Br J Surg 1996; 83:1758.
  104. Rescorla FJ, Shedd FJ, Grosfeld JL, et al. Anomalies of intestinal rotation in childhood: analysis of 447 cases. Surgery 1990; 108:710.
  105. Stolar CJ, Crisafi MA, Driscoll YT. Neurocognitive outcome for neonates treated with extracorporeal membrane oxygenation: are infants with congenital diaphragmatic hernia different? J Pediatr Surg 1995; 30:366.
  106. Muratore CS, Utter S, Jaksic T, et al. Nutritional morbidity in survivors of congenital diaphragmatic hernia. J Pediatr Surg 2001; 36:1171.
  107. Dariel A, Rozé JC, Piloquet H, et al. Impact of prophylactic fundoplication on survival without growth disorder in left congenital diaphragmatic hernia requiring a patch repair. J Pediatr 2010; 157:688.
  108. Danzer E, Zarnow D, Gerdes M, et al. Abnormal brain development and maturation on magnetic resonance imaging in survivors of severe congenital diaphragmatic hernia. J Pediatr Surg 2012; 47:453.
  109. Chen C, Jeruss S, Chapman JS, et al. Long-term functional impact of congenital diaphragmatic hernia repair on children. J Pediatr Surg 2007; 42:657.
  110. Tureczek I, Caflisch J, Moehrlen U, et al. Long-term motor and cognitive outcome in children with congenital diaphragmatic hernia. Acta Paediatr 2012; 101:507.
  111. Friedman S, Chen C, Chapman JS, et al. Neurodevelopmental outcomes of congenital diaphragmatic hernia survivors followed in a multidisciplinary clinic at ages 1 and 3. J Pediatr Surg 2008; 43:1035.
  112. Benjamin JR, Gustafson KE, Smith PB, et al. Perinatal factors associated with poor neurocognitive outcome in early school age congenital diaphragmatic hernia survivors. J Pediatr Surg 2013; 48:730.
  113. Danzer E, Gerdes M, Bernbaum J, et al. Neurodevelopmental outcome of infants with congenital diaphragmatic hernia prospectively enrolled in an interdisciplinary follow-up program. J Pediatr Surg 2010; 45:1759.
  114. Danzer E, Hedrick HL. Neurodevelopmental and neurofunctional outcomes in children with congenital diaphragmatic hernia. Early Hum Dev 2011; 87:625.
  115. Danzer E, Gerdes M, D'Agostino JA, et al. Preschool neurological assessment in congenital diaphragmatic hernia survivors: outcome and perinatal factors associated with neurodevelopmental impairment. Early Hum Dev 2013; 89:393.
  116. Danzer E, Gerdes M, D'Agostino JA, et al. Longitudinal neurodevelopmental and neuromotor outcome in congenital diaphragmatic hernia patients in the first 3 years of life. J Perinatol 2013; 33:893.
  117. Madderom MJ, Toussaint L, van der Cammen-van Zijp MH, et al. Congenital diaphragmatic hernia with(out) ECMO: impaired development at 8 years. Arch Dis Child Fetal Neonatal Ed 2013; 98:F316.
  118. Morini F, Capolupo I, Masi R, et al. Hearing impairment in congenital diaphragmatic hernia: the inaudible and noiseless foot of time. J Pediatr Surg 2008; 43:380.
  119. Fredly S, Aksnes G, Viddal KO, et al. The outcome in newborns with congenital diaphragmatic hernia in a Norwegian region. Acta Paediatr 2009; 98:107.
  120. Mah VK, Zamakhshary M, Mah DY, et al. Absolute vs relative improvements in congenital diaphragmatic hernia survival: what happened to "hidden mortality". J Pediatr Surg 2009; 44:877.
  121. Colvin J, Bower C, Dickinson JE, Sokol J. Outcomes of congenital diaphragmatic hernia: a population-based study in Western Australia. Pediatrics 2005; 116:e356.
  122. Stege G, Fenton A, Jaffray B. Nihilism in the 1990s: the true mortality of congenital diaphragmatic hernia. Pediatrics 2003; 112:532.
  123. Levison J, Halliday R, Holland AJ, et al. A population-based study of congenital diaphragmatic hernia outcome in New South Wales and the Australian Capital Territory, Australia, 1992-2001. J Pediatr Surg 2006; 41:1049.
  124. Brownlee EM, Howatson AG, Davis CF, Sabharwal AJ. The hidden mortality of congenital diaphragmatic hernia: a 20-year review. J Pediatr Surg 2009; 44:317.
  125. Nagata K, Usui N, Kanamori Y, et al. The current profile and outcome of congenital diaphragmatic hernia: a nationwide survey in Japan. J Pediatr Surg 2013; 48:738.
  126. Tsao K, Allison ND, Harting MT, et al. Congenital diaphragmatic hernia in the preterm infant. Surgery 2010; 148:404.
  127. Menon SC, Tani LY, Weng HY, et al. Clinical characteristics and outcomes of patients with cardiac defects and congenital diaphragmatic hernia. J Pediatr 2013; 162:114.
  128. Aly H, Bianco-Batlles D, Mohamed MA, Hammad TA. Mortality in infants with congenital diaphragmatic hernia: a study of the United States National Database. J Perinatol 2010; 30:553.
  129. Nasr A, Langer JC, Canadian Pediatric Surgery Network. Influence of location of delivery on outcome in neonates with congenital diaphragmatic hernia. J Pediatr Surg 2011; 46:814.
  130. Yoder BA, Lally PA, Lally KP, Congenital Diaphragmatic Hernia Study Group. Does a highest pre-ductal O(2) saturation <85% predict non-survival for congenital diaphragmatic hernia? J Perinatol 2012; 32:947.
  131. Congenital Diaphragmatic Hernia Study Group, Lally KP, Lally PA, et al. Defect size determines survival in infants with congenital diaphragmatic hernia. Pediatrics 2007; 120:e651.
  132. Singh SJ, Cummins GE, Cohen RC, et al. Adverse outcome of congenital diaphragmatic hernia is determined by diaphragmatic agenesis, not by antenatal diagnosis. J Pediatr Surg 1999; 34:1740.
  133. Tsang TM, Tam PK, Dudley NE, Stevens J. Diaphragmatic agenesis as a distinct clinical entity. J Pediatr Surg 1994; 29:1439.
  134. Lally KP, Lally PA, Van Meurs KP, et al. Treatment evolution in high-risk congenital diaphragmatic hernia: ten years' experience with diaphragmatic agenesis. Ann Surg 2006; 244:505.
  135. Lally KP, Lasky RE, Lally PA, et al. Standardized reporting for congenital diaphragmatic hernia--an international consensus. J Pediatr Surg 2013; 48:2408.
  136. Fisher JC, Jefferson RA, Arkovitz MS, Stolar CJ. Redefining outcomes in right congenital diaphragmatic hernia. J Pediatr Surg 2008; 43:373.
  137. American Academy of Pediatrics Section on Surgery, American Academy of Pediatrics Committee on Fetus and Newborn, Lally KP, Engle W. Postdischarge follow-up of infants with congenital diaphragmatic hernia. Pediatrics 2008; 121:627.
  138. Chao PH, Chuang JH, Lee SY, Huang HC. Late-presenting congenital diaphragmatic hernia in childhood. Acta Paediatr 2011; 100:425.