Postnatal management of congenital diaphragmatic hernia.

The emphasis in postnatal management has shifted from the neonatal surgical emergency approach to strategies designed to deal with pulmonary hypoplasia and the pulmonary vascular abnormalities. There has been extensive experience with alternative ventilation strategies such as ECMO and high frequency ventilation, without there being convincing evidence that these have had a major impact on mortality. Strategies that emphasize the importance of minimizing ongoing lung injury, such as pressure limited (permissive hypercapnia) ventilation and the use of surfactant replacement therapy, are beginning to show some encouraging results.