Congenital Diaphragmatic Hernia (CDH): Modern Treatment Approaches in the Fetal Period
When a diaphragm defect is detected before birth, advanced medical interventions can significantly improve outcomes.
What Is Congenital Diaphragmatic Hernia (CDH)?
Congenital Diaphragmatic Hernia (CDH) is a serious birth defect that occurs when there is an opening in the baby’s diaphragm — the muscle separating the chest and abdominal cavities. This allows abdominal organs such as the stomach, intestines, or liver to move into the chest cavity, compressing the developing lungs.
As a result, lung growth is restricted (pulmonary hypoplasia), which can lead to severe breathing difficulties after birth.
CDH affects approximately 1 in every 2,500–3,000 live births and is most often diagnosed during the second trimester via detailed ultrasound examination.
Why Is CDH So Critical?
When abdominal organs herniate into the chest cavity through the diaphragm defect, they put pressure on the developing lungs, reducing their ability to expand and function after birth.
In babies with CDH:
- Lung development is often significantly restricted.
- Cardiac displacement and circulatory imbalances may occur due to pressure.
- The risk of pulmonary hypertension increases.
Therefore, CDH requires detailed prenatal evaluation and, in selected cases, fetal intervention before delivery.
Fetal Therapy: Fetoscopic Endotracheal Balloon Occlusion (FETO)
In the absence of other major structural or chromosomal abnormalities and with a favorable fetal heart evaluation, intrauterine treatment may be considered.
The most widely used fetal intervention today is Fetoscopic Endotracheal Balloon Occlusion (FETO).
How the Procedure Works:
- Using a fetoscope (a small endoscopic camera), a balloon is placed into the baby’s trachea (windpipe).
- The balloon temporarily blocks the airway, trapping fluid within the lungs and stimulating lung tissue growth.
- After 4–6 weeks, the balloon is removed, usually before birth.
- This process enhances lung development and increases the baby’s chances of breathing independently after delivery and undergoing successful postnatal surgery.
Who Is Eligible for FETO?
FETO is recommended only for select cases that meet strict medical criteria — typically those at high risk of severe respiratory failure due to CDH.
It is most beneficial in:
- Unilateral (especially left-sided) CDH cases
- Cases where the liver has herniated into the chest cavity
- Fetuses with a Lung-to-Head Ratio (LHR) below 1.0, indicating severely limited lung growth
- Cases without chromosomal abnormalities and with normal cardiac anatomy
In summary, FETO may be considered for fetuses with severe CDH and poor postnatal survival prospects, aiming to promote lung growth before birth.
Where and By Whom Is FETO Performed?
FETO is performed exclusively in specialized fetal surgery centers by a multidisciplinary team, including:
- Perinatologists
- Pediatric surgeons
- Neonatologists
- Fetal radiologists
In Turkey, Prof. Dr. Arda Lembet is among the pioneers of fetal therapy and follows the most up-to-date, internationally standardized approaches for managing high-risk pregnancies.
Postnatal Management and Surgical Repair
While FETO does not replace postnatal surgery, it improves lung capacity and stabilization, allowing the newborn to undergo corrective surgery under better conditions.
After birth, babies with CDH are usually admitted to the neonatal intensive care unit (NICU).
They may require:
- Respiratory support (ventilation or oxygen therapy)
- Careful monitoring of lung and heart function
The diaphragm defect is surgically repaired within the first few weeks of life.
Each baby’s postnatal course and recovery plan are individually tailored based on clinical progress.
Scientific Evidence and Outcomes
Recent studies indicate that in appropriately selected cases, FETO can improve survival rates to as high as 75% in severe CDH.
The success of the procedure depends on accurate case selection, quality of prenatal monitoring, and implementation in an experienced fetal therapy center.
If your baby has been diagnosed with Congenital Diaphragmatic Hernia (CDH), we recommend a comprehensive evaluation and personalized care plan.
Please book a consultation to discuss the most suitable management options for you and your baby.
