The Resource Dilemma: Managing Congenital Diaphragmatic Hernia in Developing Health Care Systems – A Case Report

Congenital diaphragmatic hernia (CDH) is a rare congenital anomaly with a complex etiology and is frequently associated with other structural malformations. Optimal management begins with meticulous neonatal stabilization, with particular emphasis on preventing pulmonary hypertensive crises and preserving biventricular cardiac function before definitive surgical repair. Achieving favorable outcomes requires a multidisciplinary approach involving specialists in fetal medicine, radiology, neonatology, pediatric surgery, anesthesiology, and, if needed, extra-corporeal membrane oxygenation (ECMO) support. Although significant advances have been made worldwide in antenatal diagnosis, fetal surveillance, and in utero management of CDH, outcomes in developing countries remain suboptimal. Delayed antenatal diagnosis, limited access to fetal medicine specialists, inadequate referral systems, and the scarcity of advanced neonatal care facilities, including Level III neonatal intensive care units and ECMO, continue to contribute to high morbidity and mortality. This case report underscores the unique challenges of managing CDH in resource-limited settings and highlights the critical importance of timely antenatal diagnosis, early referral to specialized centers, and comprehensive multidisciplinary care in improving neonatal outcomes.