European respiratory society task force on congenital diaphragmatic hernia.

Infants with congenital diaphragmatic hernia (CDH) have significant mortality and long-term morbidity. Only 60 to 70% survive and usually in high volume centres. The current Task Force, therefore, has convened experts to evaluate the current literature and make recommendations on both the antenatal and postnatal management of CDH. The incidence of CDH varies from 1.7 to 5.7 per 10,000 live-born infants depending on the study population. Antenatal ultrasound scanning is routine and increasingly complemented by the use of magnetic resonance imaging. For isolated CDH, antenatal interventions should be considered, but the techniques need vigorous evaluation. After birth, management protocols are often used and have improved outcome in non-randomised studies, but of importance are immediate intubation at birth and gentle ventilation. Pulmonary hypertension is common and its optimal management is crucial as its severity predicts the outcome. Usually surgery is delayed to allow optimal medical stabilisation. The role of minimal invasive postnatal surgery remains to be further defined. There are differences in opinion about whether ECMO improves outcome. Survivors of CDH can have a high incidence of co-morbidities thus multidisciplinary follow up is recommended. Multicentre international trials are necessary to optimise the antenatal and postnatal management of CDH patients.