Congenital Diaphragmatic Hernia and Neonatal Lung Lesions

CDH and neonatal lung lesions are increasingly diagnosed during fetal life, and expanded use of three-dimensional ultrasound and fetal MRI have improved diagnostic detail and accuracy. Chromosomal abnormalities and severe congenital heart lesions negatively impact CDH outcome, but survival at several centers that have abandoned hyperventilation in favor of strict lung protective strategies exceeds 80% in patients who have isolated CDH. Congenital lung lesions range from small, asymptomatic imaging abnormalities to large, space-occupying lesions that cause fetal hydrops. Symptomatic lesions should be resected during infancy, and resection remains the standard for most asymptomatic lesions. Increasing numbers of reports indicate that small, asymptomatic lesions are being treated with observation and follow-up alone, and maturation of this literature is expected in the years to come.