Influence of congenital heart disease on survival in children with congenital diaphragmatic hernia.
OBJECTIVE
We sought to assess outcome in patients with CDH and HD to determine if LHR is also predictive of outcome in this subset of patients.


METHODS
We carried out a retrospective review (April 1996-October 2000) of patients with isolated CDH (n = 143, 82.2%) and patients with HD (n = 31, 17.8%) to determine the incidence of additional anomalies, survival to term, CDH repair, cardiac repair, and survival to discharge. Survival based on LHR was analyzed in a subset of fetuses.


RESULTS
The risk of death from birth to last follow-up was 2.9 times higher for patients with CDH plus HD than for patients with CDH alone (P <.0001). Of 11 patients with CDH plus HD who had CDH repair (5 of whom also had HD repair), 5 survived. All 10 patients with an LHR <1.2 died; 3 of 6 with an LHR >1.2 survived (Fisher exact test, P =.04).


CONCLUSIONS
Heart disease remains a significant risk factor for death in infants with CDH. The LHR helps predict survival in this high-risk group of patients.
Cohen
Meryl S
MS
Cardiac Center and The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia 19104, USA.
Rychik
Jack
J
Bush
David M
DM
Tian
Zhi-Yun
ZY
Howell
Lori J
LJ
Adzick
N Scott
NS
Flake
Alan W
AW
Johnson
Mark P
MP
Spray
Thomas L
TL
Crombleholme
Timothy M
TM
D000015:Abnormalities, Multiple / Q000401:mortality*; D005260:Female; D006330:Heart Defects, Congenital; D006548:Hernia, Diaphragmatic / Q000000981:diagnostic imaging / Q000401:mortality*; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D007231:Infant, Newborn; D008168:Lung / Q000473:pathology; D010414:Pennsylvania / Q000453:epidemiology; D011247:Pregnancy; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012306:Risk; D015996:Survival Rate; D016216:Ultrasonography, Prenatal