Congenital diaphragmatic hernia. A cause of persistent pulmonary hypertension of the newborn which lacks an effective therapy

Biology of the Neonate

Volumn 74, Issue 5, 1998, Pages 323-336

  Thebaud B ^a,b   Mercier, J C ^a   Dinh Xuan, A T ^b  

^a HÔPITAL ROBERT DEBRÉ   (France)

^b Univ René Descartes ^*  (France)

Author keywords

Congenital diaphragmatic hernia; Left heart hypoplasia; Lung development; Nitric oxide; Nitrofen; Outcome; Persistent pulmonary hypertension of the newborn; Pulmonary hypoplasia

Indexed keywords

ANTIOXIDANT; ENDOTHELIN 1; NITRIC OXIDE; SURFACTANT;

APOPTOSIS; BLOOD VESSEL REACTIVITY; CELL DIFFERENTIATION; CELL PROLIFERATION; CONGENITAL DIAPHRAGM HERNIA; DIAGNOSTIC VALUE; ECHOGRAPHY; FETUS; HEART; HIGH FREQUENCY VENTILATION; HUMAN; HYPOPLASIA; LUNG DEVELOPMENT; LUNG HYPOPLASIA; MORTALITY; NEWBORN; NEWBORN INTENSIVE CARE; ORGANOGENESIS; PATHOGENESIS; PATHOPHYSIOLOGY; PREDICTION; PRENATAL DIAGNOSIS; PRIORITY JOURNAL; PROGNOSIS; PULMONARY HYPERTENSION; REVIEW;

EMBRYONIC AND FETAL DEVELOPMENT; FETAL DISEASES; HERNIA, DIAPHRAGMATIC; HUMANS; HYPERTENSION, PULMONARY; INFANT, NEWBORN; INFANT, NEWBORN, DISEASES; PRENATAL DIAGNOSIS;

EID: 0031683675     PISSN: 00063126     EISSN: None     Source Type: Journal    
DOI: 10.1159/000014050     Document Type: Review

References (106)

1. Bohn D, Tamura M, Perrin D, Barker G, Rabinovitch M: Ventilatory predictors of pulmonary hypoplasia in congenital diaphragmatic hernia, confirmed by morphologic assessment. J Pediatr Surg 1987;111:423-431.
2. Levin D: Congenital diaphragmatic hernia: A persistent problem. J Pediatr 1987;111:390-392.
3. Pringle KC: Lung development in congenital diaphragmatic hernia; in Puri P (ed): Congenital Diaphragmatic Hernia. Mod Probl Paediatr. Basel, Karger, 1989, vol 24, pp28-53.
4. Siebert JR, Haas JE, Beckwith JB: Left ventricular hypoplasia in congenital diaphragmatic hernia. J Pediatr Surg 1984;19:567-571.
5. Naeye RL, Shochat SJ, Whitman V, Maisels MJ: Unsuspected pulmonary vascular abnormalities associated with diaphragmatic hernia, Pediatrics 1976;58:902-906.
6. Fauza DO, Wilson JM: Congenital diaphragmatic hernia and associated anomalies: Their incidence, identification and impact on prognosis. J Pediatr Surg 1994;29:1113-1117.
7. Metkus AP, Esserman L, Sola A, Harrison MR, Adzick NS: Cost per anomaly What does a diaphragmatic hernia cost? J Pediatr Surg 1995; 30:226-230
8. Morin L, Crombieholme TM, D'Alton ME: Prenatal diagnosis and management of fetal thoracic lesions. Semin Perinatol 1994; 18: 228-253.
9. Crane JP: Familial congenital diaphragmatic hernia: Prenatal diagnostic approach and analysis of twelve families. Clin Genet 1979; 16: 244-248.
10. Norio R, Kääriäinen H, Rapola J, Herva R, Koekomäki M: Familial congenital diaphragmatic defects: Aspects of etiology, prenatal diagnosis and treatment. Am J Med Genet 1984;17:471-483.
11. Hobolth N: Drugs and congenital abnormalities. Lancet 1962;ii:1333-1334.
12. Kup J: Zwerchfelldefekt nach Abtreibungsversuch mit Chinin. Münch Med Wochenschr 1967; 109: 2582-2583.
13. Powell JD, Johnstone JM: Phenometrazine and foetal abnormalities. Br Med J 1962;ii;1327.
14. Sweed Y, Puri P: Congenital diaphragmatic hernia: Influence of associated malformations on survival. Arch Dis Child 1993;69:68-70.
15. Butler N, Claireaux AE: Congenital diaphragmatic hernia as a cause of perinatal mortality. Lancet 1962;i: 659-663
16. Cuniff C, Jones KL, Jones MC: Patterns of malformation in children with congenital diaphragmatic defects. J Pediatr 1990;116:258-261.
17. Tubinsky M, Sevein C, Rapoport JM: Fryns syndrome: A new variable multiple congenital anomaly (MCA) syndrome. Am J Med Genet 1983;14:461-463.
18. Adamson IYR: Development of lung structure; in Crystal RG, West JB, Weibel ER, Barnes PJ (eds): The Lung: Scientific Foundations, ed 2. Philadelphia, Lippincott Raven Publishers, 1997, pp 993-1001.
19. Reid L: Lung growth in health and disease. Br J Dis Chest 1984;78: 113-134.
20. Kitterman JA: Development and growth of the respiratory system; in Rudolph AM, Hoffman JIE, Rudolph CD (eds): Rudolph's Pediatrics, ed 20. Norwalk, Appleton & Lange, 1998, pp 1569-1570.
21. Burri PH: Postnatal development and growth; in Crystal RG, West JB, Weibel ER, Barnes PJ (eds): The Lung: Scientific Foundations, ed 2. Philadelphia, Lippincott Raven Publishers, 1997, pp 1013-1026.
22. Hislop A, Reid LM: Intrapulmonary arterial development during fetal life: Branching pattern and structure. J Anat 1972;113:35-48.
23. Kluth D, Petersen C, Zimmermann HJ: The developmental anatomy of congenital diaphragmatic hernia. Pediatr Surg Int 1987;2:322-326.
24. Stark D: Embryologie, ed 3. Stuttgart, Thieme, 1975.
25. Bremer JL: The diaphragm and diaphragmatic hernia. Arch Pathol 1943;36:539-549.
26. Wells LJ: Development of the human diaphragm and pleural sacs. Contrib Embryol Carnegie Inst 1954;35:107-137.
27. Iritani I: Experimental study on embryogenesis of congenital diaphragmatic hernia. Anat Embryol 1984; 169:133-139.
28. De Lorimer AA, Tierney DF, Parker HR. Hypoplastic lungs in fetal lambs with surgically produced congenital diaphragmatic hernia. Surgery 1967;62:12-17.
29. Kent GMK, Olley PM, Creighton RE, Dobbinson T: Hemodynamic and pulmonary changes following surgical creation of a diaphragmatic hernia in fetal lambs. Surgery 1972; 72:427-433.
30. Harrison MR, Jester JA, Ross NA: Correction of congenital diaphragmatic hernia in utero. I. The model: Intrathoracic balloon produces fatal pulmonary hypoplasia. Surgery 1980;88:174-182.
31. Kluth D, Tenbrink R, Ekesparre M, Kangah R, Reich P, Brandsma A, Tibboel D, Lambrecht W: The natural history of congenital diaphragmatic hernia and pulmonary hypoplasia in the embryo. J Pediatr Surg 1993;28:456-463.
32. Costlow R, Manson JM: Effects of the herbicide 2,4-dichlorophenyl-p-nitrophenyl ether (nitrofen) on fetal lung development in rats. Toxicology 1981;20:195-207.
33. Costlow R, Manson JM. The heart and the diaphragm: Target organs in the neonatal death induced by nitrofen. Toxicology 1981;20:209-227.
34. Manson JM: Mechanism of nitrofen teratogenesis. Environ Health Perspect 1986;70:137-147.
35. Alles AJ, Losty PD, Donahoe PK, Manganaro TF, Schnitzer JJ: Embryonic cell death patterns associated with nitrofen-induced congenital diaphragmatic hernia. J Pediatr Surg 1995;30:353-360.
36. Ohkawa H, Matsumoto M, Hori T, Kashiwa H: Familial congenital diaphragmatic hernia in the pig - Studies on pathology and heredity. Eur J Pediatr Surg 1993;3:67-71.
37. Areechon W, Reid L: Hypoplasia of lung with congenital diaphragmatic hernia. Br Med J 1963;i:230-233.
38. Kitagawa M, Hislop A, Boyden EA, Reid L: Lung hypoplasia: A quantitative study of airway, artery and alveolar development. Br J Surg 1971;58:342-346.
39. Geggel RL, Murphy JD, Langleben D, Crone RK, Vacanti JP, Reid LM: Congenital diaphragmatic hernia: Arterial structural changes and persistent pulmonary hypertension after surgical repair. J Pediatr Surg 1985;107:457-464.
40. Stolar C, Dillon P, Stalcup SA: Extracorporeal membrane oxygenation and congenital diaphragmatic hernia: Modification of the pulmonary vasoactive profile. J Pediatr Surg 1985;20:681-683.
41. Halbower AC, Tuder RM, Franklin WA, Pollock JS, Fostermann U, Abman SH: Maturation-related changes in endothelial nitric oxide synthase immunolocalization in developing ovine lung. Am J Physiol 1994;267:L585-L591.
42. Karamanoukian HL, Glick PL, Wilcox DT, Rossman JE, Azizkhan RG: Pathophysiology of congenital diaphragmatic hernia. X. Localization of nitric oxide synthase in the intima of pulmonary artery trunks of lambs with surgically created congenital diaphragmatic hernia. J Pediatr Surg 1994;30:5-9.
43. North AJ, Moya FR, Mysore ML, Thomas VL, Wells LB, Wu LC, Shaul PW: Pulmonary nitric oxide synthase gene expression is decreased in a rat model of congenital diaphragmatic hernia. Am J Respir Cell Mol Biol 1995;13:676-682.
44. Karamanoukian HL, Peay T, Love JE, Abdel-Rahman E, Dandonna P, Azizkhan RG, Glick PL: Decreased pulmonary nitric oxide synthase activity in the rat model of congenital diaphragmatic hernia. J Pediatr Surg 1996;31:1016-1019.
45. Kobayashi H, Puri P: Plasma endothelin levels in congenital diaphragmatic hernia. J Pediatr Surg 1994; 29:1258-1261.
46. Thébaud B, de Lagausie P, Souil E, Aigrain Y, Mercier JC, Dinh-Xuan AT: Pulmonary vasodilation is not impaired in congenital diaphragmatic hernia. Am J Respir Crit Care Med 1997;155:948A.
47. Okazaki T, Sharma HS, McCune SK, Tibboel D: Pulmonary vascular balance in congenital diaphragmatic hernia: Enhanced endothelin-1 gene expression as a possible cause of pulmonary vasoconstriction. J Pediatr Surg 1998;33:81-84.
48. Moya FR, Thomas VL, Romaguera J, Mysore MR, Maberry M, Bernard A, Freund M: Fetal lung maturation in congenital diaphragmatic hernia. Am J Obstet Gynecol 1995;173: 1401-1405.
49. Glick PL, Stannard VA, Leach CL, Rossmann J, Hosada Y, Morin FC, Cooney DR, Allen JE, Holm B: Pathophysiology of congenital diaphragmatic hernia II: The fetal lamb CDH model is surfactant deficient. J Pediatr Surg 1992;27:382-388.
50. Alfonso LF, Arnaiz A, Alvarez FJ: Lung hypoplasia and surfactant system immaturity induced in the fetal rat by prenatal exposure to nitrofen. Biol Neonate 1996;69:94-100.
51. Lotze A, Knight GR, Anderson KD, Hull WM, Whitsett JA, O'Donnell RM, Martin G, Bulas D, Short BL: Surfactant (beractant) therapy for infants with congenital diaphragmatic hernia on ECMO: Evidence of persistent surfactant deficiency. J Pediatr Surg 1994;29:407-412.
52. Sluiter W, Bos AP, Silveri F, Tenbrinck R, Kraakslee R, Tibboel D, Koster JF, Molenaar JC: Nitrofen induced diaphragmatic hernia in rats: Pulmonary antioxidant enzyme activities. Pediatr Res 1992; 32:394-398.
53. Ijsselstijn H, Pacheco BA, Albert A, Sluiter W, Donahoe PK, De Jongste JC, Schnitzer JJ, Tibboel D: Prenatal hormones alter antioxydant enzymes and lung histology in rats with congenital diaphragmatic hernia. Am J Physiol 1997;72:L1059-L1065.
54. Crawford DC, Drake DP, Kwaitkowski D, Chapman MG, Allan LD: Prenatal diagnosis of reversible cardiac hypoplasia associated with congenital diaphragmatic hernia: Implications for postnatal management. J Clin Ultrasound 1986;14:718-721.
55. Karamanoukian HL, Glick PL, Wilcox DT, O'Toole SJ, Rossman JE, Azizkhan RG: Pathophysiology of congenital diaphragmatic hernia. XI. Anatomic and biochemical characterization of the heart in the fetal lamb CDH model. J Pediatr Surg 1995;30:925-929.
56. Schwartz SM, Vermilion RP, Hirschl RB: Evaluation of left ventricular mass in children with left-sided congenital diaphragmatic hernia. J Pediatr 1994;125:447-451.
57. Harrison MR, Adzick S, Estes J, Howell LJ: A prospective study of outcome for fetuses with diaphragmatic hernia. JAMA 1994;271:382-384.
58. Sweed Y, Puri P: Congenital diaphragmatic hernia: Influence of associated malformation on survival. Arch Dis Child 1993;69:68-70.
59. Burge DM, Atwell JD, Freeman NV: Could the stomach site help predict outcome in babies with left sided congenital diaphragmatic hernia diagnosed antenatally? J Pediatr Surg 1989;24:567-569.
60. Crawford DC, Wright VW, Drake DP, Allan LD: Fetal diaphragmatic hernia: The value of fetal echocardiography in the prediction of postnatal outcome. Br J Obstet Gynecol 1989;96:705-710.
61. Johnson A, Callan NA, Bhutani VK, Colmorgan GHC, Weiner S, Bolognese RG: Ultrasonic ratio of fetal thoracic to abdominal circumference: An association with pulmonary hypoplasia. Am J Obstet Gynecol 1987;157:764-769
62. Kamata S, Hasegawa T, Ishikawa S: Prenatal diagnosis of congenital diaphragmatic hernia and perinatal care: Assessment of lung hypoplasia. Early Hum Dev 1992;29:375-379.
63. Metkus AP, Filly RA, Stringer MD, Harrison MR, Adzick NS: Sonographic predictors of survival in fetal diaphragmatic hernia. J Pediatr Surg 1996;31:148-152.
64. Thébaud B, Azancot A, de Lagausie P, Vuillard E, Ferkadji L, Benali K, Beaufils F: Congenital diaphragmatic hernia: Antenatal prognostic factors. Does left ventricular disproportion in utero predict outcome and pulmonary hypoplasia? Intensive Care Med 1997;23:1062-1069.
65. Vacanti JP, O'Rourke PP, Lillehei CW, Crone RK: The cardiopulmonary consequences of high-risk congenital diaphragmatic hernia. Pediatr Surg Int 1988;3:1-5.
66. Cartlidge PHT, Mann NP, Kapila L: Preoperative stabilization in congenital diaphragmatic hernia. Arch Dis Child 1986;61:1226-1228.
67. Hazebroek F, Tibboel D, Bos A, Pattenier AW, Madern GC, Bergmeijer JH, Moleenar JC: Congenital diaphragmatic hernia: Impact of preoperative stabilization. A prospective pilot study in 13 patients. J Pediatr Surg 1988;23:1139-1146.
68. Sigalet DR, Tierney A, Adolph V, Perrault T, Finer N, Hallgren R, Laberge JM: Timing of repair of congenital diaphragmatic hernia requiring extracorporeal membrane oxygenation support. J Pediatr Surg 1995;30:1183-1187.
69. Moffitt ST, Schulze KF, Sahni R, Wung J, Myers MM, Stolar CJH: Preoperative cardiorespiratory trends in infants with congenital diaphragmatic hernia. J Pediatr Surg 1995;30:604-611.
70. Glick PL, Leach CL, Besner GE, Egan EA, Morin FC, Malanowska-Kantoch A, Robinson LK, Brady A, Lele AS, McDonnell M, Holm B, Rodgers BT, Msall ME, Courey NG, Karp MP, Allen JE, Jewett TC, Cooney DR: Pathophysiology of congenital diaphragmatic hernia. III. Exogenous surfactant therapy for high-risk neonate with CDH. J Pediatr Surg 1992;27:866-869.
71. Bos AP, Tibboel D, Hazebroek FWJ, Moleenar JC, Lachman B, Gommers D: Surfactant replacement therapy in high-risk congenital diaphragmatic hernia. Lancet 1991; 338:1279.
72. Clark RH: High frequency ventilation. J Pediatr 1994;124:661-670.
73. Miguet D, Claris O, Lapillone A, Bakr A, Chapuis JP, Salle BL: Preoperative stabilization using high-frequency oscillatory ventilation in the management of congenital diaphragmatic hernia. Crit Care Med 1994;29:S77-S82.
74. Wilcox D, Glick PL, Karamanoukian HL, Leach C, Morin FC III, Fuhrman BP: Perflubron associated gas exchange improves pulmonary mechanics, oxygenation, ventilation and allows nitric oxide delivery in the hypoplastic lung congenital diaphragmatic hernia lamb model. Crit Care Med 1995;23:1858-1863.
75. Pranikoff T, Gauger PG, Hirschl R: Partial liquid ventilation in newborn patients with congenital diaphragmatic hernia. J Pediatr Surg 1996;31:613-618.
76. Zhang S, Garbutt V, McBride JT: Strain induced growth of the immature lung. J Appl Physiol 1996;81: 1471-1476.
77. Roberts JD, Polaner DM, Lang P, Zapol WM: Inhaled nitric oxide in persistent pulmonary hypertension of the newborn. Lancet 1992;340: 818-819.
78. Kinsella JP, Neish SR, Ivy DD, Shaffer E, Abman SH: Clinical responses to prolonged treatment of persistent pulmonary hypertension of the newborn with low doses of inhaled nitric oxide. J Pediatr 1993; 123:103-108.
79. Henneberg SW, Jepsen S, Andersen PK, Pedersen SA: Inhalation of nitric oxide as a treatment of pulmonary hypertension in congenital diaphragmatic hernia. J Pediatr Surg 1995;30:853-855
80. Mercier JC, Dehan M and the French Pediatric Study group of inhaled NO: Inhalational nitric oxide in persistent pulmonary hypertension of the newborn: Results of the French multicenter open study. Am J Respir Crit Care Med 1994;149: A545.
81. The Neonatal Inhaled Nitric Oxide Study Group (NINOS): Inhaled nitric oxide and hypoxic respiratory failure in infants with congenital diaphragmatic hernia. Pediatrics 1997;99:838-845.
82. Kinsella J, Truog W, Walsh WF, Goldberg RN, Bancalari E, Mayock DE, Redding GJ, de Lemos RA, Sardesai S, McCumin DC, Moreland SG, Cutter GR, Abman S: Randomized, multicenter trial of inhaled nitric oxide and high-frequency oscillatory ventilation in severe, persistent pulmonary hypertension of the newborn. J Pediatr 1997;131:51-62.
83. Bartlett RH, Gazzaniga AB, Tomasian J, Corwin AC, Roloff D, Rucker R: Extracorporeal membrane oxygenation (ECMO) in neonatal respiratory failure. Ann Surg 1986;204: 236-245.
84. Wilson JM, Lund DP, Lillehei CW, Vacanti JP: Congenital diaphragmatic hernia: Predictors of severity in the ECMO era. J Pediatr Surg 1991;26:1028-1034.
85. Bernbaum J, Schwartz IP, Gerdes M, D'Agostino JA, Coburn CE, Polin RA: Survivors of extracorporeal membrane oxygenation at 1 year of age: The relationship of primary diagnosis with health and neurodevelopmental sequelae. Pediatrics 1995;96:907-913.
86. Harrison MR, Adzick SN, Flake AW, Jennings RW, Estes JM, Mac Gilliwray TE, Chueh JT, Goldberg JD, Filly RA, Goldstein RB, Rosen MA, Cauldwell C, Levine AH, Howell LJ: Correction of congenital diaphragmatic hernia in utero. VI. Hard earned lessons. J Pediatr Surg 1993;28:1411-1417.
87. Strang LB: Fetal lung liquid: Secretion and reabsorption. Physiol Rev 1991;71:991-1016.
88. Alcorn D, Adamson TM, Lambert TF: Morphological effects of chronic tracheal ligation and drainage in the fetal lamb lung. J Anat 1976;22: 649-660.
89. Moessinger AC, Harding R, Adamson TM, Singh M, Kim G: Role of lung liquid volume in growth and maturation of the fetal sheep lung. J Clin Invest 1990;86:1270-1277.
90. Fewell JE, Hislop A, Kitterman JA, Johnson P: Effect of tracheostomy on lung development in fetal lambs. J Appl Physiol 1983;55:1103-1108.
91. Richards DS, Yancey MK, Duff P, Stieg FH: The perinatal management of severe laryngeal stenosis. Obstet Gynecol 1992;80:537-540.
92. Hashim E, Laberge JM, Chen MF, Quillen EW Jr: Reversible iracheal obstruction in the fetal sheep: Effects on tracheal fluid pressure and lung growth. J Pediatr Surg 1995;30: 1172-1177.
93. Di Fiore JW, Fauza DO, Slavin R, Peters CA, Fackler JC, Wilson JM: Experimental tracheal ligation reverses the structural and physiological effects of pulmonary hypoplasia in congenital diaphragmatic hernia. J Pediatr Surg 1994;29:248-257.
94. Curtis AS, Seehar GM: The control of cell division by tension or fusion. Nature 1978;274:52-53.
95. Liu M, Skinner SJ, Xu J: Stimulation of fetal rat lung cell proliferation in vitro by mechanical stress. Am J Physiol 1992;263:376-383.
96. Hedrick MH, Estes JM, Sullivan KM, Bealer JF, Kitterman JA, Flake AW, Adzick SN, Harrison MR: Plug the lung until it grows (PLUG): A new method to treat congenital diaphragmatic hernia in utero. J Pediatr Surg 1994;29:612-637.
97. Ford WDA, Cool JC, Parsons D, Martin EJ, Kennedy JD, Lipsett J, Byard RW, Slater AJ: Congenital diaphragmatic hernia: Lung compliance after antenatal tracheal obstruction or surgical correction of the defect. Pediatr Surg Int 1996;11: 524-527.
98. O'Toole S, Sharma A, Karamanoukian H, Holm B, Azizkhan R, Glick PL: Tracheal ligation does not correct the surfactant deficiency associated with CDH. J Pediatr Surg 1996;31:1-16.
99. Harrison MR, Adzick NS, Flake AW, Van der Wall KJ, Bealer JF, Howell LJ, Farell JA, Filly RA, Rosen MA, Sola A, Goldberg JD: Correction of congenital diaphragmatic hernia in utero. VIII. Response of the hypoplastic lung to tracheal occlusion. J Pediatr Surg 1996;31: 1339-1348.
100. Skarsgard ED, Meuli M, Van der Wall KJ, Bealer JF, Adzick SN, Harrison MR: Fetal endoscopic tracheal occlusion (Fetendo-PLUG) for congenital diaphragmatic hernia. J Pediatr Surg 1996; 31:1335-1338.
101. Suen HC, Block KD, Donahoe PK: Antenatal glucocorticoid corrects pulmonary immaturity in experimental congenital diaphragmatic hernia in rats. Pediatr Res 1994;35:523-529.
102. Suen HC, Losty P, Donahoe PK, Schnitzer JJ: Combined antenatal thyrotropin-releasing hormone and low-dose glucocorticoid therapy improves the pulmonary biochemical immaturity in congenital diaphragmatic hernia. J Pediatr Surg 1994;29:359-363.
103. Ballard RA, Ballard PL, Creasy RK, Padbury J, Polk DH, Bracken M, Moya FR, Gross I and the TRH Study Group: Respiratory disease in very-low-birthweight infants after prenatal thyrotropin-releasing hormone and glucocorticoid. Lancet 1992;339:510-515.
104. Zhou HY, Gao YS, Usha Raj J: Antenatal betamethasone therapy augments NO-mediated relaxation of preterm ovine pulmonary veins. Am J Physiol 1996;80:L390-L396.
105. Nambi P, Pullen M, Wu HL, Nuthulaganti P, Elshourbagy N, Kumar C: Dexamethasone downregulages the expression of endothelin receptors in vascular smooth muscle. J Biol Biochem 1992;267: 19555-19559.
106. Tannuri U, Maksoud Filho JG, Diniz EMA, Santos MM, Tanuri AC, Rodriguez CJ, Rodriguez AJ: Prenatal intraamniotic administration of surfactant substance improves lung compliance and morphometric parameters in an animal model of congenital diaphragmatic hernia. Pediatr Res 1996; 2094:352A.