Neonatal Surgery

What is CDH Repair?

Congenital diaphragmatic hernia repair returns abdominal contents to the abdomen and reconstructs the defective diaphragm. The key to survival is pre-operative stabilization of pulmonary hypertension — surgery is deferred until the baby is physiologically stable.

Why China?

• Pediatric expertise: Shanghai Children's, PUMC, Beijing Children's Hospitals have dedicated fetal-neonatal surgery teams
• Cost: $20,000-$40,000 vs. $100,000-$300,000 in the US
• Fetoscopic intervention (FETO): Available for severe CDH at select centers
• ECMO support: Major pediatric centers have neonatal ECMO programs

Who is a candidate?

• Neonates with CDH diagnosed prenatally or at birth
• After physiologic stabilization (typically day 3-7)
• Left-sided CDH (most common) or right-sided
• Late-presenting CDH in older infants/children

Outcomes

Survival to discharge: 65-85% depending on severity. Long-term pulmonary outcomes: mostly normal in survivors. Recurrence with patch: 5-15%. Feeding difficulties/GERD common in first 1-2 years. Long-term survivors: excellent quality of life.