Antenatal assessment of liver position, rather than lung-to-head ratio (LHR) or observed/expected LHR, is predictive of outcome in fetuses with isolated left-sided congenital diaphragmatic hernia
Language English Country Great Britain, England Media print-electronic
Document type Journal Article
- Keywords
- Congenital diaphragmatic hernia, outcome, prenatal diagnosis, respiratory morbidity,
- MeSH
- Gestational Age MeSH
- Head diagnostic imaging embryology MeSH
- Liver diagnostic imaging embryology MeSH
- Humans MeSH
- Logistic Models MeSH
- Lung diagnostic imaging embryology MeSH
- Prognosis MeSH
- Retrospective Studies MeSH
- Pregnancy MeSH
- Ultrasonography, Prenatal * MeSH
- Hernias, Diaphragmatic, Congenital diagnosis embryology mortality MeSH
- Check Tag
- Humans MeSH
- Pregnancy MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
OBJECTIVES: Respiratory morbidity in congenital diaphragmatic hernia (CDH) is associated with high mortality and adverse outcome. Accurate prenatal diagnosis is essential for prognosis and potential treatment in utero. The aim was to evaluate the prenatal ultrasound findings in assessing the respiratory prognosis in fetuses with isolated left-sided CDH. METHODS: We retrospectively analyzed the medical records of 59 prenatally diagnosed left-sided CDH cases managed at a tertiary perinatal center. RESULTS: Survival rate in the study group was 73% (43/59). We found no statistically significant relationship between survival and the presence of polyhydramnios, gestational age at diagnosis, lung-to-head ratio (LHR) and observed/expected LHR (O/E LHR) values, gestational age at birth and birth weight. Intrathoracic liver herniation was a statistically significant parameter adversely affecting survival (37.2% in survivors, 68.8% in non-survivors, p = 0.031) and logistic regression confirmed this relationship. The presence of pneumothorax and severe pulmonary hypertension were significantly associated with mortality (82% non-survivors versus 15% in survivors, p = 0.0001). CONCLUSION: Intrathoracic liver herniation seems to be a reliable parameter in the prediction of survival and neonatal respiratory morbidity in fetuses with isolated left-sided CDH. In contrast, we found no significant correlation between perinatal outcome and LHR, O/E LHR values, birth weight and gestational age.
3rd Faculty of Medicine Charles University Prague Czech Republic
b Fetal Medicine Centre Institute for the Care of Mother and Child Prague Czech Republic and
c Department of Pediatric Surgery 2nd Faculty of Medicine Prague Czech Republic
References provided by Crossref.org
