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Eur J Pediatr Surg 2014; 24(03): 270-277
DOI: 10.1055/s-0034-1382262
Review
Georg Thieme Verlag KG Stuttgart · New York

Medical and Regenerative Solutions for Congenital Diaphragmatic Hernia: A Perinatal Perspective

Jan Deprest
1   Department of Development and Regeneration, KU Leuven, Leuven, Belgium
2   Division Woman and Child, University Hospitals Leuven, Leuven, Belgium
,
Leonardo Gucciardo
1   Department of Development and Regeneration, KU Leuven, Leuven, Belgium
3   Department of Obstetrics, University Hospital Brussels, Vrije Universiteit Brussel, Brussels, Belgium
,
Patrice Eastwood
1   Department of Development and Regeneration, KU Leuven, Leuven, Belgium
,
Silvia Zia
1   Department of Development and Regeneration, KU Leuven, Leuven, Belgium
,
Julio Jimenez
1   Department of Development and Regeneration, KU Leuven, Leuven, Belgium
,
Francesca Russo
1   Department of Development and Regeneration, KU Leuven, Leuven, Belgium
,
Flore Lesage
1   Department of Development and Regeneration, KU Leuven, Leuven, Belgium
,
Liesbeth Lewi
1   Department of Development and Regeneration, KU Leuven, Leuven, Belgium
2   Division Woman and Child, University Hospitals Leuven, Leuven, Belgium
,
Maurilio Sampaolesi
1   Department of Development and Regeneration, KU Leuven, Leuven, Belgium
,
Jaan Toelen
1   Department of Development and Regeneration, KU Leuven, Leuven, Belgium
2   Division Woman and Child, University Hospitals Leuven, Leuven, Belgium
› Author Affiliations
Further Information

Publication History

19 May 2014

22 May 2014

Publication Date:
17 June 2014 (online)

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Abstract

In the EU-27, 2,100 babies with congenital diaphragmatic hernia (CDH) are born annually. CDH is fatal in 30% of them. Experimental fetal surgery in severe cases results in a survival rate of 50 to 60% at its best. Failure is due to insufficient lung growth, persistent pulmonary hypertension or prematurity induced by the procedure. For nonsurvivors alternative strategies are required. Survivors undergo anatomical repair, but large diaphragmatic defects are closed using a patch. At present the used materials are less than ideal, mainly because of recurrence and chest deformation. To overcome the above limitations, alternative medical therapies (pharmacologic or cell therapy) that are more potent and less invasive are needed. Also a more functional postnatal repair may be possible when using novel scaffolds or engineered constructs. We see a prominent place for autologous amniotic fluid-derived stem cells for these novel strategies, which could be prenatally harvested following appropriate patient selection by noninvasive imaging.

Keywords

diaphragmatic hernia - pulmonary hypoplasia - tissue engineering - stem cell - amniotic fluid
 

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