Prenatal prediction of survival in isolated left‐sided diaphragmatic hernia

• DOI: 10.1002/uog.2688
• Publication Date: 2005-12-22T14:16:43Z
• Authors: J. Jani; R. L. Keller; A. Benachi; K. H. Nicolaides; R. Favre; E. Gratacos; J. Laudy; V. Eisenberg; A. Eggink; P. Vaast; J. Deprest
• Keywords: NCEBP 12: Human Reproduction; Hernia, Diaphragmatic; Infant, Newborn; EBP 2: Effective Hospital Care; Gestational Age; Survival Analysis; 3. Good health; 03 medical and health sciences; 0302 clinical medicine; UMCN 2.1: Heart, lung and circulation; Predictive Value of Tests; Pregnancy; Prenatal Diagnosis; Humans; Regression Analysis; Female; Hernias, Diaphragmatic, Congenital; EMC MGC-02-53-01-A; Head; Lung; UMCN 5.2: Endocrinology and reproduction

AbstractObjectiveTo investigate the potential value of antenatally determined intrathoracic herniation of the liver and the ratio of fetal lung area to head circumference (LHR) in the prediction of postnatal survival in isolated, left‐sided congenital diaphragmatic hernia (CDH).MethodsIn this multicenter study, we searched the antenatal‐CDH‐Registry for fetuses with isolated left‐sided CDH that were liveborn after 30 weeks of gestation and were followed up postnatally for at least 3 months after discharge from hospital. The patients were subdivided into those with and those without intrathoracic herniation of the liver and into subgroups according to the LHR that had been measured between 22 + 0 and 28 + 0 weeks of gestation. The rate of survival in each group and subgroup of patients was determined and compared.ResultsThe registry search identified 184 patients that fulfilled the entry criteria. Logistic regression analysis demonstrated that significant predictors of survival were the presence or absence of intrathoracic herniation of the liver and the LHR. In 86 cases there was liver herniation (Group A) and in 98 the liver was confined to the abdomen (Group B). In Group A, the survival rate was 50.0% and was significantly associated with LHR; in Group B the survival rate was 76.5% and was unrelated to LHR.ConclusionIn isolated, left‐sided CDH, the postnatal mortality rate is substantially higher if there is intrathoracic herniation of the liver. In fetuses with liver herniation, measurement of LHR at 22–28 weeks of gestation is useful in the prediction of subsequent survival. Copyright © 2005 ISUOG. Published by John Wiley & Sons, Ltd.