Prenatal prognostic factors for isolated right congenital diaphragmatic hernia: a single center’s experience

Abstract Background Right-sided congenital diaphragmatic hernia (RCDH) is relatively rare compared with left-sided congenital diaphragmatic hernia (LCDH). Clinical data of RCDH, especially with respect to antenatal prediction of neonatal outcome, are lacking. The aim of this study was to report the treatment outcomes of patients with antenatally diagnosed RCDH and to evaluate the predictability of observed-to-expected lung area-to-head circumference ratio (O/E LHR) for perinatal outcomes, focused on mortality or extracorporeal membrane oxygenation (ECMO) requirement. Methods We retrospectively reviewed the medical records of newborn infants with isolated RCDH. We analyzed and compared the clinical and prenatal characteristics including the fetal lung volume, which was measured as the O/E LHR, between the survivors and the non-survivors. Results A total of 26 (66.7%) of 39 patients with isolated RCDH survived to discharge. The O/E LHR was significantly greater in survivors (64.7 ± 21.2) than in non-survivors (40.5 ± 23.4) (P =.027). It was greater in survivors without ECMO requirement (68.3 ± 15.1) than non-survivors or those with ECMO requirement (46.3 ± 19.4; P = .010). The best O/E LHR cut-off value for predicting mortality in isolated RCDH was 50. Conclusions The findings in this study suggest that O/E LHR, a well-characterized prognostic indicator in LCDH, could be applied to a fetus with antenatally diagnosed RCDH. A large cohort study is required to verify the association between O/E LHR values and the graded severity of RCDH.

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Prenatal Diagnosis of Congenital Diaphragmatic Hernia: Does Laterality Predict Perinatal Outcomes?

American Journal of Perinatology ◽

10.1055/s-0037-1617754 ◽

2018 ◽

Vol 35 (10) ◽

pp. 919-924 ◽

Cited By ~ 5

Author(s):

Teresa Sparks ◽

Victoria Berger ◽

Jody Farrell ◽

Kristen Gosnell ◽

Roberta Keller ◽

...

Keyword(s):

Congenital Diaphragmatic Hernia ◽

Diaphragmatic Hernia ◽

Poor Prognosis ◽

Primary Outcome ◽

Mode Of Delivery ◽

Perinatal Outcomes ◽

Lung Area ◽

Liver Herniation ◽

Secondary Outcomes ◽

Univariate Analyses

Objective The objective of this study was to examine laterality as a predictor of outcomes among fetuses with prenatally diagnosed congenital diaphragmatic hernia (CDH). Methods This is a retrospective cohort study of pregnancies with CDH evaluated at our center from 2008 to 2016 compared cases with right-sided CDH (RCDH) versus left-sided CDH (LCDH). The primary outcome was survival to discharge. Secondary outcomes included ultrasound predictors of poor prognosis (liver herniation, stomach herniation, lung area-to-head circumference ratio [LHR]), concurrent anomalies, hydrops, stillbirth, preterm birth, mode of delivery, small for gestational age, use of extracorporeal membrane oxygenation, and length of stay. Terminations and stillbirths were excluded from analyses of neonatal outcomes. Results In this study, 157 (83%) LCDH and 32 (17%) RCDH cases were identified. Survival to discharge was similar (64 vs. 66.4%, p = 0.49) with regard to laterality. RCDH had higher rates of liver herniation (90.6 vs. 72%, p = 0.03), hydrops fetalis (15.6 vs. 1.3%, p < 0.01), and lower LHR (0.87 vs. 0.99, p = 0.04). LCDH had higher rates of stomach herniation (69.4 vs. 12.5%, p < 0.01). Rates of other outcomes were similar in univariate analyses. Adjusting for microarray abnormalities, the odds for survival to discharge for RCDH compared with LCDH was 0.93 (0.38–2.30, p = 0.88). Conclusion Compared with LCDH, fetuses with RCDH had higher rates of adverse ultrasound predictors, but equivalent survival.

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212: Ultrasound estimates of fetal lung volume: what is the best predictor of perinatal outcomes in congenital diaphragmatic hernia?

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2013.10.245 ◽

2014 ◽

Vol 210 (1) ◽

pp. S114-S115

Author(s):

Amanda Trudell ◽

Tasnim Najaf ◽

Geetika Khanna ◽

Alison Cahill ◽

Methodius Tuuli ◽

...

Keyword(s):

Congenital Diaphragmatic Hernia ◽

Diaphragmatic Hernia ◽

Lung Volume ◽

Perinatal Outcomes ◽

Fetal Lung

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Quantitative Lung Index, Contralateral Lung Area, or Lung-to-Head Ratio to Predict the Neonatal Outcome in Isolated Congenital Diaphragmatic Hernia?

Journal of Ultrasound in Medicine ◽

10.7863/jum.2013.32.3.413 ◽

2013 ◽

Vol 32 (3) ◽

pp. 413-417 ◽

Cited By ~ 14

Author(s):

Rodrigo Ruano ◽

Eduardo Takashi ◽

Marcos Marques da Silva ◽

Sina Haeri ◽

Uenis Tannuri ◽

...

Keyword(s):

Congenital Diaphragmatic Hernia ◽

Diaphragmatic Hernia ◽

Neonatal Outcome ◽

Contralateral Lung ◽

Lung Area

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OC20.05: Quantitative lung index, contralateral lung area or lung-to-head ratio to predict neonatal outcome in isolated congenital diaphragmatic hernia?

Ultrasound in Obstetrics and Gynecology ◽

10.1002/uog.11351 ◽

2012 ◽

Vol 40 (S1) ◽

pp. 41-41

Author(s):

R. Ruano ◽

E. Takashi ◽

M. M. Silva ◽

S. Haeri ◽

U. Tannuri ◽

...

Keyword(s):

Congenital Diaphragmatic Hernia ◽

Diaphragmatic Hernia ◽

Neonatal Outcome ◽

Contralateral Lung ◽

Lung Area

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Prenatal Prognostic Factors for Isolated Right Congenital Diaphragmatic Hernia: A Single Center’s Experience

10.21203/rs.3.rs-763037/v1 ◽

2021 ◽

Author(s):

Jiyoon Jeong ◽

Byong Sop Lee ◽

Teahyen Cha ◽

Euiseok Jung ◽

Ellen Ai-Rhan Kim ◽

...

Keyword(s):

Congenital Diaphragmatic Hernia ◽

Diaphragmatic Hernia ◽

Newborn Infants ◽

Area Under The Curve ◽

Fetal Lung ◽

Ecmo Support ◽

Prognostic Indicators ◽

Short Term ◽

Support Area ◽

Postnatal Outcome

Abstract Background: Right-sided congenital diaphragmatic hernia (RCDH) is relatively rare. Clinical data of RCDH, especially with respect to antenatal prediction of neonatal outcome, are lacking. This study aimed to report the treatment outcome of newborn infants with RCDH and to identify prenatal prognostic indicators. Methods: We retrospectively reviewed the medical records of newborn infants with isolated RCDH who were born at a gestational age of ≥35 weeks. We analyzed and compared the clinical and prenatal characteristics including the fetal lung volume, which was measured as the observed-to-expected lung area-to-head circumference ratio (O/E LHR), between the survivors and non-survivors. Results: A total of 24 (70.6%) of 34 patients with isolated RCDH survived to discharge. The O/E LHR was significantly greater in survivors (67.0 ± 19.9) than in non-survivors (42.4 ± 25.0) (P < .05). In multivariate analysis, the O/E LHR was found to be a good predictor of mortality or requirement for extracorporeal membrane oxygenation (ECMO) support (area under the curve [AUC], 0.870; P < .01) and mortality (AUC, 0.789; P < .05). The best O/E LHR cut-off value for predicting mortality and mortality or requirement for ECMO support in isolated RCDH was 47. Conclusions: The survival rate of patients with isolated RCDH was comparable to that of patients with left-sided CDH. The O/E LHR of the contralateral lung was a reliable predictor of short-term postnatal outcome in RCDH.

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