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Am J Perinatol 2018; 35(09): 823-836
DOI: 10.1055/s-0037-1618603
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Antenatal Medical Therapies to Improve Lung Development in Congenital Diaphragmatic Hernia

Aidan Kashyap
1   The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Australia
2   Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia
,
Philip DeKoninck
1   The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Australia
2   Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia
,
Kelly Crossley
1   The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Australia
2   Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia
,
Marta Thio
3   Newborn Research Centre, The Royal Women's Hospital, Melbourne, Australia
4   Centre of Research Excellence in Newborn Medicine, Murdoch Children's Research Institute, Melbourne, Australia
5   Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Australia
6   PIPER – Neonatal Retrieval Services Victoria, The Royal Children's Hospital, Melbourne, Australia
,
Graeme Polglase
1   The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Australia
2   Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia
,
Francesca Maria Russo
7   Division of Woman and Child, Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium
8   Department of Development and Regeneration, Cluster Woman and Child, Faculty of Medicine, KU Leuven, Belgium
,
Jan Deprest
7   Division of Woman and Child, Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium
8   Department of Development and Regeneration, Cluster Woman and Child, Faculty of Medicine, KU Leuven, Belgium
9   Institute for Women's Health, University College London Hospital, London, United Kingdom
,
Stuart Hooper
1   The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Australia
2   Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia
,
Ryan Hodges
1   The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Australia
2   Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia
10   Monash Women's Service, Monash Health, Melbourne, Australia
› Author Affiliations
Further Information

Publication History

10 July 2017

05 December 2017

Publication Date:
16 January 2018 (online)

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Abstract

Congenital diaphragmatic hernia (CDH) is a birth defect characterized by failed closure of the diaphragm, allowing abdominal viscera to herniate into the thoracic cavity and subsequently impair pulmonary and vascular development. Despite improving standardized postnatal management, there remains a population of severe CDH for whom postnatal care falls short. In these severe cases, antenatal surgical intervention (fetoscopic endoluminal tracheal occlusion [FETO]) may improve survival; however, FETO increases the risk of preterm delivery, is not widely offered, and still fails in half of cases. Antenatal medical therapies that stimulate antenatal pulmonary development are therefore interesting alternatives. By presenting the animal research underpinning novel antenatal medical therapies for CDH, and considering the applications of these therapies to clinical practice, this review will explore the future of antenatal CDH management with a focus on the phosphodiesterase-5 inhibitor sildenafil.

Keywords

congenital diaphragmatic hernia - antenatal therapy - fetal - sildenafil - pulmonary hypertension of the newborn - pulmonary hypoplasia