Congenital diaphragmatic hernia: prenatal diagnosis permits immediate intensive care with high survival rate in isolated cases. A population-based study.
OBJECTIVE
To estimate the prognosis of prenatally diagnosed isolated congenital diaphragmatic hernia (PDICDH) treated with 'immediate planned care' (IPC) between 1999 and 2003 in Eastern Brittany.


METHODS
The prognosis of PDICDH was compared with the prognosis of the other live-born CDH, either prenatally undiagnosed or not having had IPC. IPC consisted in prenatal lung maturation with corticosteroids, elective caesarean section at 37 weeks, immediate intubation, surfactant, high- frequency ventilation or oscillation, nitric oxide, intravenous prostacyclin, anaesthesia and haemodynamic support. Surgical repair was performed in the NICU 34 h after birth.


RESULTS
The incidence of CDH was 0.8 per thousand with a prenatal diagnosis rate of 27/30 (90%), leading to a termination of pregnancy in nine cases. Ten CDH were associated with other malformations. IPC in PDICDH was performed in 12 cases. The survival rate of PDICDH with IPC was 11/12 versus 1/9 in CDH with no IPC or no prenatal diagnosis (p < 0.01). Logistic regression analysis showed that IPC was determinant for survival (p < 0.01).


CONCLUSIONS
Prenatal diagnosis of isolated CDH treated with immediate planned care is associated with a high survival rate. This suggests that prenatal diagnosis associated with specifically adapted postnatal procedure may improve the prognosis of isolated CDH.
Centre Pluridisciplinaire de Diagnostic Prénatal (CPDP) and Réseau Est Bretagne d'Etudes en Médecine Périnatale (REBEMP), Rennes, France. pierre.betremieux@chu-rennes.fr
Pierre
P
Bétrémieux
Théophile
T
Gaillot
Armelle
A
de la Pintière
Alain
A
Beuchée
Laurent
L
Pasquier
Edouard
E
Habonimana
Gwénaelle
G
Le Bouar
Bernard
B
Branger
Joëlle
J
Milon
Benjamin
B
Frémond
Eric
E
Wodey
Sylvie
S
Odent
Patrice
P
Poulain
Patrick
P
Pladys
D000305:Adrenal Cortex Hormones / Q000494:pharmacology / Q000627:therapeutic use; D002585:Cesarean Section; D005260:Female; D005315:Fetal Diseases / Q000175:diagnosis* / Q000196:embryology / Q000628:therapy; D005325:Fetal Organ Maturity / Q000187:drug effects; D005865:Gestational Age; D006548:Hernia, Diaphragmatic / Q000175:diagnosis* / Q000196:embryology / Q000628:therapy; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D015931:Intensive Care, Neonatal; D016015:Logistic Models; D008168:Lung / Q000187:drug effects / Q000196:embryology; D008297:Male; D011247:Pregnancy; D011296:Prenatal Diagnosis; D011446:Prospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones