Hemodynamic precision to guide surgical timing for neonates with congenital diaphragmatic hernia: a narrative review

Abstract

Despite a near universal approach focused on physiologic stabilization prior to surgical repair of congenital diaphragmatic hernia (CDH), a condition with significant morbidity and mortality, there remains a lack of consensus, or even guidance, on the appropriate timing for diaphragmatic reconstruction. Hemodynamic-directed care has increasingly been incorporated into the post-natal, peri-operative care of CDH, including assessments of pulmonary hypertension and ventricular dysfunction. Herein, we discuss the integration of targeted neonatal echocardiography and hemodynamic-based assessments to guide precision-directed care and inform selection of the optimal surgical repair window in this complex, heterogeneous patient population.