Newborns with diaphragmatic hernia: initial chest radiography does not have a role in predicting clinical outcome.
BACKGROUND
The management of life-threatening congenital diaphragmatic hernia (CDH) has undergone significant change over the last two decades. When CDH was felt to be a surgical emergency treated promptly after birth, survival rates of 50% were typical. Recent changes in medical management of these patients prior to surgery have had a dramatic influence on clinical outcome with survival rates over 80%.


OBJECTIVE
This study was performed to assess under the current 80% survival rates whether there is predictive value in the appearance of the initial chest radiograph and clinical outcome in patients with CDH.


METHODS
Initial chest radiographs on 56 newborns with CDH were retrospectively reviewed for percent aeration of ipsilateral lung, percent aeration of contralateral lung, percent mediastinal shift, and content of hernia and correlated with clinical outcome.


RESULTS
There was no significant relationship between radiographic analysis of the percent of ipsilateral lung aeration (P=0.43), contralateral aeration (P=0.52) mediastinal shift (P=0.18), or content of hernia and clinical outcome. All CDH lesions tend to "look the same" on radiographs, regardless of favorable or fatal outcome.


CONCLUSIONS
Chest radiography serves to confirm the diagnosis of CDH, but does not predict outcome.
Holt
Peter D
PD
Department of Radiology, Children's Hospital of New York-Presbyterian, 3959 Broadway, CHN 325, New York, NY 10032, USA.
Arkovitz
Marc S
MS
Berdon
Walter E
WE
Stolar
Charles J
CJ
D005260:Female; D006548:Hernia, Diaphragmatic / Q000000981:diagnostic imaging* / Q000401:mortality; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D011237:Predictive Value of Tests; D013902:Radiography, Thoracic; D012189:Retrospective Studies; D015996:Survival Rate