\\n\\n
Released this past November, the list is based on data collected from the Web of Science and highlights some of the world’s most influential scientific minds by naming the researchers whose publications over the previous decade have included a high number of Highly Cited Papers placing them among the top 1% most-cited.
\\n\\nWe wish to congratulate all of the researchers named and especially our authors on this amazing accomplishment! We are happy and proud to share in their success!
Note: Edited in March 2021
\\n"}]',published:!0,mainMedia:{caption:"Highly Cited",originalUrl:"/media/original/117"}},components:[{type:"htmlEditorComponent",content:'IntechOpen is proud to announce that 191 of our authors have made the Clarivate™ Highly Cited Researchers List for 2020, ranking them among the top 1% most-cited.
\n\nThroughout the years, the list has named a total of 261 IntechOpen authors as Highly Cited. Of those researchers, 69 have been featured on the list multiple times.
\n\n\n\nReleased this past November, the list is based on data collected from the Web of Science and highlights some of the world’s most influential scientific minds by naming the researchers whose publications over the previous decade have included a high number of Highly Cited Papers placing them among the top 1% most-cited.
\n\nWe wish to congratulate all of the researchers named and especially our authors on this amazing accomplishment! We are happy and proud to share in their success!
Note: Edited in March 2021
\n'}],latestNews:[{slug:"webinar-introduction-to-open-science-wednesday-18-may-1-pm-cest-20220518",title:"Webinar: Introduction to Open Science | Wednesday 18 May, 1 PM CEST"},{slug:"step-in-the-right-direction-intechopen-launches-a-portfolio-of-open-science-journals-20220414",title:"Step in the Right Direction: IntechOpen Launches a Portfolio of Open Science Journals"},{slug:"let-s-meet-at-london-book-fair-5-7-april-2022-olympia-london-20220321",title:"Let’s meet at London Book Fair, 5-7 April 2022, Olympia London"},{slug:"50-books-published-as-part-of-intechopen-and-knowledge-unlatched-ku-collaboration-20220316",title:"50 Books published as part of IntechOpen and Knowledge Unlatched (KU) Collaboration"},{slug:"intechopen-joins-the-united-nations-sustainable-development-goals-publishers-compact-20221702",title:"IntechOpen joins the United Nations Sustainable Development Goals Publishers Compact"},{slug:"intechopen-signs-exclusive-representation-agreement-with-lsr-libros-servicios-y-representaciones-s-a-de-c-v-20211123",title:"IntechOpen Signs Exclusive Representation Agreement with LSR Libros Servicios y Representaciones S.A. de C.V"},{slug:"intechopen-expands-partnership-with-research4life-20211110",title:"IntechOpen Expands Partnership with Research4Life"},{slug:"introducing-intechopen-book-series-a-new-publishing-format-for-oa-books-20210915",title:"Introducing IntechOpen Book Series - A New Publishing Format for OA Books"}]},book:{item:{type:"book",id:"5208",leadTitle:null,fullTitle:"Microporous and Mesoporous Materials",title:"Microporous and Mesoporous Materials",subtitle:null,reviewType:"peer-reviewed",abstract:"The aim of this book has been to explore the variety of phenomena associated with the major forms of the material, while laying the foundation for a clear and detailed working and understanding of the materials. We tried to present new types of advanced materials, which are currently a hot topic, and provide readers with a selective review of important improvements in the field. I believe that every chapter in this book presents the progress in the subject and describes the latest advances in microporous and mesoporous materials.",isbn:"978-953-51-2583-9",printIsbn:"978-953-51-2582-2",pdfIsbn:"978-953-51-6671-9",doi:"10.5772/61556",price:119,priceEur:129,priceUsd:155,slug:"microporous-and-mesoporous-materials",numberOfPages:174,isOpenForSubmission:!1,isInWos:null,isInBkci:!1,hash:"f4b3d2b7a3778bd3f9ff9019d886fc88",bookSignature:"Reza Sabet Dariani",publishedDate:"August 24th 2016",coverURL:"https://cdn.intechopen.com/books/images_new/5208.jpg",numberOfDownloads:12489,numberOfWosCitations:19,numberOfCrossrefCitations:12,numberOfCrossrefCitationsByBook:0,numberOfDimensionsCitations:18,numberOfDimensionsCitationsByBook:1,hasAltmetrics:1,numberOfTotalCitations:49,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"October 20th 2015",dateEndSecondStepPublish:"November 10th 2015",dateEndThirdStepPublish:"February 14th 2016",dateEndFourthStepPublish:"May 14th 2016",dateEndFifthStepPublish:"June 13th 2016",currentStepOfPublishingProcess:5,indexedIn:"1,2,3,4,5,6,7",editedByType:"Edited by",kuFlag:!1,featuredMarkup:null,editors:[{id:"175069",title:"Prof.",name:"Reza",middleName:null,surname:"Sabet Dariani",slug:"reza-sabet-dariani",fullName:"Reza Sabet Dariani",profilePictureURL:"https://mts.intechopen.com/storage/users/175069/images/4730_n.jpg",biography:"Dr. Reza Sabet Dariani completed his PhD in Physics at the age of 32 from the University of New South Wales and Postdoctoral position from the Queen’s University. He is now Professor of Physics at the Alzahra University and Editor-in-Chief of the Alzahra University Journal of Applied Physics. He received the Third World Academy of Science (TWAS) grants for Spare Parts for Scientific Equipment, Trieste, Italy in 2002, and was Winner of the SVC best poster, The Society of Vacuum Coaters, Washington DC in 2006. He has published more than 97 papers in reputed journals and 113 conference papers, and is also a reviewer of several international journals.",institutionString:null,position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"1",totalChapterViews:"0",totalEditedBooks:"1",institution:{name:"Universitas Azzahra",institutionURL:null,country:{name:"Indonesia"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,coeditorOne:null,coeditorTwo:null,coeditorThree:null,coeditorFour:null,coeditorFive:null,topics:[{id:"945",title:"Mineralogy",slug:"mineralogy"}],chapters:[{id:"51220",title:"The Increase of the Micoporosity and CO2 Adsorption Capacity of the Commercial Activated Carbon CWZ-22 by KOH Treatment",doi:"10.5772/63672",slug:"the-increase-of-the-micoporosity-and-co2-adsorption-capacity-of-the-commercial-activated-carbon-cwz-",totalDownloads:1857,totalCrossrefCites:7,totalDimensionsCites:9,hasAltmetrics:0,abstract:"The chemical modification of CWZ-22—commercial activated carbon (AC) with KOH‐ to enhance CO2 adsorption was examined. The effect of different impregnation ratios KOH:CWZ-22 from 1 to 4 was studied. The ACs were characterized by CO2 and N2 sorption, Fourier transform infrared (FTIR), SEM, and XRD methods.",signatures:"Joanna Sreńscek-Nazzal, Urszula Narkiewicz, Antoni W. Morawski,\nRafał J. Wróbel and Beata Michalkiewicz",downloadPdfUrl:"/chapter/pdf-download/51220",previewPdfUrl:"/chapter/pdf-preview/51220",authors:[{id:"181572",title:"Prof.",name:"Beata",surname:"Michalkiewicz",slug:"beata-michalkiewicz",fullName:"Beata Michalkiewicz"},{id:"181578",title:"Dr.",name:"Joanna",surname:"Sreńscek-Nazzal",slug:"joanna-srenscek-nazzal",fullName:"Joanna Sreńscek-Nazzal"},{id:"181614",title:"Prof.",name:"Urszula",surname:"Narkiewicz",slug:"urszula-narkiewicz",fullName:"Urszula Narkiewicz"},{id:"181615",title:"Prof.",name:"Antoni W.",surname:"Morawski",slug:"antoni-w.-morawski",fullName:"Antoni W. Morawski"},{id:"181616",title:"Prof.",name:"Rafał",surname:"Wróbel",slug:"rafal-wrobel",fullName:"Rafał Wróbel"}],corrections:null},{id:"50108",title:"Application of Some Natural Porous Raw Materials for Removal of Lead and Zinc from Aqueous Solutions",doi:"10.5772/62347",slug:"application-of-some-natural-porous-raw-materials-for-removal-of-lead-and-zinc-from-aqueous-solutions",totalDownloads:1374,totalCrossrefCites:2,totalDimensionsCites:2,hasAltmetrics:1,abstract:"This chapter discusses the adsorption of lead and zinc ions onto a natural zeolite (clinoptilolite) and zeolite bearing tuff (stilbite) from aqueous solution, whereby the main parameters were the effects of initial pH of solution, mass of adsorbent, and initial metal concentration in solution.",signatures:"Mirjana Golomeova and Afrodita Zendelska",downloadPdfUrl:"/chapter/pdf-download/50108",previewPdfUrl:"/chapter/pdf-preview/50108",authors:[{id:"181115",title:"D.Sc.",name:"Afrodita",surname:"Zendelska",slug:"afrodita-zendelska",fullName:"Afrodita Zendelska"},{id:"181339",title:"Prof.",name:"Mirjana",surname:"Golomeova",slug:"mirjana-golomeova",fullName:"Mirjana Golomeova"}],corrections:null},{id:"50822",title:"Synthesis and Characterization of CMK Porous Carbons Modified with Metals Applied to Hydrogen Uptake and Storage",doi:"10.5772/63710",slug:"synthesis-and-characterization-of-cmk-porous-carbons-modified-with-metals-applied-to-hydrogen-uptake",totalDownloads:1730,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"In this chapter, we have shown that hopeful hydrogen storage material can be obtained by ordered mesoporous carbons (carbons mesostructured from Korea, CMK-1 and CMK-3) and modified with metal/cations species. The pristine CMK-1 and CMK-3 were synthesized by replication using MCM-48 and SBA-15 as hard templates and sucrose as a carbon source. Incorporation of metal species was carried out by wetness impregnation. The mesoporous materials modified were characterized by X-ray diffraction (XRD), X-ray photoelectron spectra (XPS), RAMAN, transmission electron microscopy (TEM), and adsorption/desorption N2 isotherms. Carbon modified with metal/cations shows a better capacity for hydrogen uptake than that of the mesoporous carbons. The evolution of high-pressure hydrogen adsorption measured at 77 K shows that composites can significantly enhance hydrogen adsorption capacity and hydrogen storage performance of carbon materials, proving to be prospective candidates for application in hydrogen storage. The improved activity and the larger performance of composite materials are attributed to improved dispersion of uniform metal/cations nanoparticles as well as to efficient use of the support, which may originate a high-surface area and pore volume, allowing a large dispersion of clusters.",signatures:"Marcos B. Gómez Costa, Juliana M. Juárez and Oscar A. Anunziata",downloadPdfUrl:"/chapter/pdf-download/50822",previewPdfUrl:"/chapter/pdf-preview/50822",authors:[{id:"179933",title:"Prof.",name:"Oscar",surname:"Anunziata",slug:"oscar-anunziata",fullName:"Oscar Anunziata"},{id:"185384",title:"Dr.",name:"Marcos B.",surname:"Gómez Costa",slug:"marcos-b.-gomez-costa",fullName:"Marcos B. Gómez Costa"},{id:"185385",title:"Dr.",name:"Juliana M.",surname:"Juárez",slug:"juliana-m.-juarez",fullName:"Juliana M. Juárez"}],corrections:null},{id:"50262",title:"Mesoporous Carbons for Energy-Efficient Water Splitting to Produce Pure Hydrogen at Room Temperature",doi:"10.5772/62503",slug:"mesoporous-carbons-for-energy-efficient-water-splitting-to-produce-pure-hydrogen-at-room-temperature",totalDownloads:1623,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Theoretical and experimental aspects of the use of mesoporous carbons in carbon-assisted water electrolysis (CAWE) to produce pure hydrogen at room temperature are presented. It is shown that the electrical energy requirements for CAWE can be as low as 20% of the energy needed for conventional water electrolysis, the extra energy coming from the electrochemical oxidation of carbon occurring at room temperature. Although CO2 is produced at the anode in this process, it is well separated from pure H2 produced at the cathode. Experimental results are reviewed for a variety of carbons with the major focus on the results obtained with carbon BP2000, which has both mesopores and micropores and a nanocarbon produced by the hydrothermal treatment of microcrystalline cellulose.",signatures:"Mohindar S. Seehra and Vishal Narang",downloadPdfUrl:"/chapter/pdf-download/50262",previewPdfUrl:"/chapter/pdf-preview/50262",authors:[{id:"48086",title:"Prof.",name:"Mohindar",surname:"Seehra",slug:"mohindar-seehra",fullName:"Mohindar Seehra"},{id:"185053",title:"Dr.",name:"Vishal",surname:"Narang",slug:"vishal-narang",fullName:"Vishal Narang"}],corrections:null},{id:"50761",title:"Biomass, Abundant Resources for Synthesis of Mesoporous Silica Material",doi:"10.5772/63463",slug:"biomass-abundant-resources-for-synthesis-of-mesoporous-silica-material",totalDownloads:2186,totalCrossrefCites:0,totalDimensionsCites:2,hasAltmetrics:0,abstract:"The synthesis of mesoporous silica materials was reviewed with a view to discuss the reaction mechanism and the various attempts made at enhancing the materials’ properties by utilizing varieties of templating agents and silica frameworks from pure synthetic chemicals. This chapter also reviewed studies in which either the template or the framework was synthesized from benign reagents obtained from renewable sources, to achieve enhanced material properties. The view was to encourage the development of mesoporous silica materials in which both the template and the silica framework are from biomass origin. This approach may promote the large‐scales synthesis of mesoporous silica for commercial purposes, which had previously been hampered by the toxic nature, cost of synthetic chemical reagents, and unsustainable synthetic routes.",signatures:"Adebola Iyabode Akinjokun, Tunde Victor Ojumu and Aderemi\nOkunola Ogunfowokan",downloadPdfUrl:"/chapter/pdf-download/50761",previewPdfUrl:"/chapter/pdf-preview/50761",authors:[{id:"161208",title:"Prof.",name:"T.V.",surname:"Ojumu",slug:"t.v.-ojumu",fullName:"T.V. Ojumu"},{id:"181469",title:"M.Sc.",name:"Adebola",surname:"Akinjokun",slug:"adebola-akinjokun",fullName:"Adebola Akinjokun"}],corrections:null},{id:"51586",title:"Overview of Phosphorus Effect in Molybdenum-Based Hydrotreating Catalysts Supported on Ordered Mesoporous Siliceous Materials",doi:"10.5772/64181",slug:"overview-of-phosphorus-effect-in-molybdenum-based-hydrotreating-catalysts-supported-on-ordered-mesop",totalDownloads:1711,totalCrossrefCites:1,totalDimensionsCites:3,hasAltmetrics:0,abstract:"This chapter presents an overview of the literature on the effect of phosphorus modification of ordered mesoporous silica (OMS) such as MCM-41, HMS, SBA-15, and SBA-16 to be used as supports for hydrotreating catalysts based on transition metal sulfides (TMS). The influence of the support modification with variable quantities of phosphorus on the performance for hydrodesulfurization (HDS) and hydrodenitrogenation (HDN) reactions is outlined and discussed considering the changes in the structural and textural properties (SBET), acidity, reducibility, etc., of the substrate brought about by phosphorus incorporation.",signatures:"Rafael Huirache-Acuña, Eric M. Rivera-Muñoz, Trino A. 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Rivera-Muñoz"},{id:"185436",title:"Dr.",name:"Trino",surname:"Zepeda",slug:"trino-zepeda",fullName:"Trino Zepeda"}],corrections:null},{id:"51675",title:"Microporous and Mesoporous Materials in Decontamination of Water Process",doi:"10.5772/64393",slug:"microporous-and-mesoporous-materials-in-decontamination-of-water-process",totalDownloads:2010,totalCrossrefCites:2,totalDimensionsCites:2,hasAltmetrics:0,abstract:"Water pollution is the main threat that confronts humanity today. The daily human activity introduces different pollutants in hydric sources that modify water quality. This represents a high production of water that is not appropriate for different applications like human consumption. Among the water pollutants more common are dyes, herbicides, pesticides, alkanes, halo alkanes, aliphatic compounds, alcohols, carboxylic acids, aromatic compounds, detergents, surfactants, inorganic compounds (heavy metals), harmful gases, and pathogenic bacteria (bacteria and virus). These pollutants can be found in underground and surface water, and therefore can produce adverse effects on the environment and human health. These effluents can be treated with different procedures such as biological and chemical treatments, among others. However, in some cases, these processes are not appropriate for compliance legislation. 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The magnitude of the effect of interventions that modify one Quality Adjusted Life Years (QALYs) will be compared, and the transferability of these interventions globally will be investigated by comparison between different socio-economic countries with different government structures (from socialist to autocratic). The reproducibility and cost of the lifestyle interventions (e.g., exercise, sleep, nutritious diet, national child care, pollution limitations) on QALYs will also be documented. The ratio of (QALY/Cost) weighted by reproducibility and transferability should give a rank-ordered list of actions humans can take to increase the quality years of human consciousness. Differences in the optimized list of rank-ordered interventions to maximize the quality of life between nation-states with varying GDP and government types (i.e., the lack of transferability) will be discussed. These local maximums for QALY optimization will be discussed in light of possible avenues that allow countries to overcome national hurdles that allow them to reach greater QALY global maximums.
\r\n\r\n\tThis book welcomes topics related to the quality of life measurements (QALYs) both within a community and between disparate societies, as well as the transferability/durability of these QALY gains.
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It appears to be due to an error in the development of the pleuro-peritoneal canals and therefore develops around 6 weeks of gestation [1]. Its incidence is 1:3000 live births. Progress in the management of these patients has significantly increased survival rates (up to 90% [3]), but disease-related morbidity remains very high: the main problem is the compression exerted by the herniated viscera on the developing lungs, development, which causes pulmonary hypoplasia and hypertension [4].
CDH can be classified, depending on the location of the defect, into postero-lateral, or Bochdalek’s hernia (70–75%), anterior or Morgagni’s hernia (23–28%) and central or hiatal hernia (2–7%) [4]. Morgagni’s hernia is often discovered incidentally in older children, as it rarely causes such a mass effect on the thoracic level as to compromise the development of the lungs. Bochdalek’s hernia is the form that is classically referred to when talking about this pathology and to which we will refer accordingly in the next paragraphs (26). Most often it is located on the left side (85%), but it can also be right (13%) or bilateral (2%) [4].
The pathogenesis of CDH is complex and currently still little known. Some studies have shown that pulmonary hypoplasia in these patients arises before the development of the diaphragm itself. This discovery opened the door to the so-called “double hit theory” which sees pulmonary hypoplasia as the result of two insults: the first, affecting both lungs, would be due to genetic and environmental factors (for example alcohol, smoking, obesity, low intake of retinoids during pregnancy); the second, which would affect only the lung ipsilateral to the defect, would consist of the compressive effect of the herniated viscera and their interference with normal fetal respiratory movements. Multiple studies have demonstrated the importance of the genetic component in the pathogenesis of ECD: they often fall within syndromic pictures, and about 40% of cases are associated with other congenital anomalies, especially cardiovascular (11–15% of ECD) [4].
Given the potential severity of the disease, prenatal counseling represents a fundamental phase of the diagnostic-therapeutic process of CDH: parents must be adequately informed about all the steps to be taken and the risks in terms of mortality and morbidity.
Ultrasound currently represents the gold standard in CDH diagnosis, although it has been calculated that less than two-thirds of CDHs are detected on prenatal screening ultrasound scans. The mean gestational age at diagnosis is 24–25 weeks, more advanced in cases of isolated defects than in CDHs associated with other anomalies. The typical ultrasound sign is the presence of abdominal organs (intestinal loops, stomach, liver) in the chest. Indirect signs of CDH can be changes in the heart axis, polyhydramnios, mediastinal shift. The differential diagnosis includes all congenital pulmonary malformations, bronchial atresia, intestinal duplications and mediastinal masses [5, 6]. The execution of genetic tests and second-level imaging tests is essential for defining the prenatal management strategy, whether it is inclined towards termination of pregnancy, or whether it is oriented towards fetal therapies. One of the main prognostic factors is represented by the lung to head ratio (LHR), which by measuring the length of the lung contralateral to the hernia normalized for the head circumference, provides an indirect estimate of pulmonary hypoplasia. More specifically, since the LHR changes with advancing gestational age, we prefer to use the ratio between observed LHR and expected LHR (observed/expected LHR or o/and LHR).
One or/and LHR <25% is indicative of severe hypoplasia, while one/and LHR of 25–35% or an LHR of 35–45% with herniated liver are indicative of moderate hypoplasia. In fact, another prognostic factor is represented by the position of the liver: since the liver and the fetal lung are poorly distinguishable ultrasonographically, there may be an indication to perform a fetal magnetic resonance [3, 4, 5, 6]. It allows to evaluate not only the presence or absence of liver in the thoracic cavity, but also to quantify the observed/expected total fetal lung volume (or/and TFLV), which was a better predictor in terms of postnatal survival. As an alternative to magnetic resonance evaluation of the or/and TFLV, some authors have demonstrated a close relationship between the liver herniation, the position of the stomach (which being anechoic is much more easily identifiable) and the postnatal outcome. Finally, given the high frequency with which EDC is associated with cardiovascular anomalies, there is an indication to perform fetal echocardiography [7, 8].
The prenatal management of fetuses affected by CDH essentially provides for an ultrasound monitoring of the ultrasound parameters described above, associated in doubtful cases with second level examinations such as resonance. In recent years, however, fetal therapy has become increasingly popular on the international scene, indicated in cases where negative prognostic factors are detected in screening investigations (liver herniation, LHR <1.0). The purpose of these interventions is essentially to stop the mechanisms that induce the onset of complications such as pulmonary hypoplasia and pulmonary hypertension as early as possible. The technique currently most used is fetal tracheal occlusion (FETO): it is based on the principle that the occlusion of the trachea prevents the leakage of fluids, increasing the pressure in the airways and promoting lung growth. However, animal models have shown that tracheal occlusion reduces the maturation of type II pneumocytes, inducing a surfactant deficiency: for this reason the so-called “plug-unplug” sequence was devised, in which the patency of the trachea is first interrupted by the introduction of a balloon (or plug) and then re-established before delivery to allow lung maturation. This procedure can be performed percutaneously under ultrasound guidance or fetoscopy, typically between 27 and 32 weeks of gestational age, with the plug removed at 34 weeks. This procedure appears to be associated with increased survival in children with moderate and severe CDH, although further risk-benefit studies are certainly needed.
In children with CDH, the only medical treatment for which there is evidence of efficacy is corticosteroid therapy: maternal administration of one or two doses of corticosteroids at 34–36 weeks of gestation appears to be correlated with a reduction in respiratory morbidity at birth. Promising studies are also underway on the prenatal use of retinoids and phosphodiesterase inhibitors (Sildenafil) and on the use of stem cells from amniotic fluid in combination with FETO [4].
The optimal timing and modality of delivery for children with CDH are still under discussion today. There seem to be no indications for induced delivery before 38 weeks of gestation, as well as there do not seem to be any advantages in performing a cesarean section. On the other hand, a unanimous consensus was found on the importance of planning the birth in a third-level center, where a multidisciplinary group (gynecologists, neonatologists, surgeons and pediatric anesthetists) is available, capable of managing the disease [4].
At birth, the main objective must be to ensure adequate ventilatory support (without triggering a vasospasm or further lung damage) and induce not too deep sedation (which would further compromise respiratory function). In case of respiratory distress, endotracheal intubation is carried out directly: in fact, ventilation with a facial mask must be avoided, as it would lead to distension of the stomach and intestinal loops, worsening the respiratory dynamics.
For the same principle, the positioning of a nasogastric tube is indicated at the same time, in order to decompress the stomach as much as possible. It is considered acceptable to maintain reduced saturation levels and a certain degree of hypercapnia, as long as the pH is kept above 7.2: in the presence of acidosis, in fact, vascular resistance would increase and consequently the risk of pulmonary hypertension. Another major problem in these patients is hemodynamic instability: to assess the need for inotropic support, these patients must be continuously monitored from a pressure point of view and postnatal echocardiography (within 48 h of life) must be performed if necessary repeated at 2–3 weeks. The indication for the ECMO, as a bridge to surgery in the most compromised patients, is still much debated. One of the biggest challenges remains the management of pulmonary hypertension: currently the most widely used treatment is inhaled nitric oxide, although encouraging new studies are underway on the use of Sildenafil [2, 4, 5].
Surgical treatment of CDH should be planned in election, after the achievement of hemodynamic stability. The only case in which it is acceptable to perform an emergency operation is when there are signs of ischemia of the herniated intestinal loops. As for the surgical technique, this can be performed openly (in thoracotomy or laparotomy) or by minimally invasive techniques. The intervention consists in the repositioning of the herniated organs within the abdomen and consequently in the closure of the defect, which can be primary or with a patch depending on the size of the defect. Minimally invasive techniques and the use of a patch were associated with a higher relapse rate [3, 4].
In light of the increased survival of newborns with CDH, long-term outcomes, especially in terms of quality of life, have assumed increasing importance over time. The most compromised organs are certainly the lungs: in addition to the well-known pulmonary hypertension, these children experience alterations both in a restrictive sense (due to pulmonary hypoplasia) and in an obstructive sense (similar to bronchodysplasia of the premature infant) [8]. Pulmonary function seems to gradually restore during childhood, but recent studies have shown a slight deterioration of the same from childhood to adulthood. The respiratory system is not the only one affected by this disease. Gastroesophageal reflux is present in 45–89% of children with CDH and appears to be correlated with the size of the defect. Stunted growth is also a frequent finding, affecting 69% of these children at 1 year of age. Neurological alterations (in terms of delay in neurodevelopment but also sensorineural deafness) represent one of the most feared and also most frequent complications of CDH, with incidence rates ranging from 12 to 77%, especially in children undergoing ECMO. Finally, musculoskeletal deformities (chest anomalies, hemithorax asymmetries, scoliosis) were reported in 21–48% of patients treated for CDH [3].
All this, together with the fact that a good percentage of CDHs fall into syndromic pictures or are associated with other congenital anomalies, justifies the importance of a long-term follow-up program.
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