Prenatal prediction of survival in isolated left-sided diaphragmatic hernia.
OBJECTIVE
To investigate the potential value of antenatally determined intrathoracic herniation of the liver and the ratio of fetal lung area to head circumference (LHR) in the prediction of postnatal survival in isolated, left-sided congenital diaphragmatic hernia (CDH).


METHODS
In this multicenter study, we searched the antenatal-CDH-Registry for fetuses with isolated left-sided CDH that were liveborn after 30 weeks of gestation and were followed up postnatally for at least 3 months after discharge from hospital. The patients were subdivided into those with and those without intrathoracic herniation of the liver and into subgroups according to the LHR that had been measured between 22 + 0 and 28 + 0 weeks of gestation. The rate of survival in each group and subgroup of patients was determined and compared.


RESULTS
The registry search identified 184 patients that fulfilled the entry criteria. Logistic regression analysis demonstrated that significant predictors of survival were the presence or absence of intrathoracic herniation of the liver and the LHR. In 86 cases there was liver herniation (Group A) and in 98 the liver was confined to the abdomen (Group B). In Group A, the survival rate was 50.0% and was significantly associated with LHR; in Group B the survival rate was 76.5% and was unrelated to LHR.


CONCLUSIONS
In isolated, left-sided CDH, the postnatal mortality rate is substantially higher if there is intrathoracic herniation of the liver. In fetuses with liver herniation, measurement of LHR at 22-28 weeks of gestation is useful in the prediction of subsequent survival.
Jani
J
J
Fetal Medicine and Treatment Units of the University Hospital Gasthuisberg, Leuven, Belgium.
Keller
R L
RL
Fetal Medicine and Treatment Units of the University of California at San Francisco, San Francisco, CA, USA.
Benachi
A
A
Fetal Medicine and Treatment Units of the Hôpital Necker-Enfants Malades, Paris, France.
Nicolaides
K H
KH
Fetal Medicine and Treatment Units of the King's College Hospital, London, UK.
Favre
R
R
Fetal Medicine and Treatment Units of the CMCO de Schiltigheim, Strasbourg, France.
Gratacos
E
E
Fetal Medicine and Treatment Units of the Vall d'Hebron Hospital, Barcelona, Spain.
Laudy
J
J
Fetal Medicine and Treatment Units of the Erasmus Medical Center, Rotterdam, The Netherlands.
Eisenberg
V
V
Fetal Medicine and Treatment Units of the Sheba Medical Center, Tel Hashomer, Israel.
Eggink
A
A
Fetal Medicine and Treatment Units of the UMC Sint Radboud, Nijmegen, The Netherlands.
Vaast
P
P
Fetal Medicine and Treatment Units of the Hôpital Jeanne de Flandre, CHRU Lille, France.
Deprest
J
J
Fetal Medicine and Treatment Units of the University Hospital Gasthuisberg, Leuven, Belgium.
The ad-hoc Antenatal-CDH-Registry Group also includes: D. Van Schoubroeck, G. Naulaers (Leuven, Belgium); M. Harrison (San Francisco, CA, USA); H. Vandecruys (London, UK); D. Mitanchez (Paris, France); J. Matis (Strasbourg, France); A. Delelis (Lille, France); O. Moreno (Barcelona, Spain); D. Tibboel (Rotterdam, The Netherlands); A. van Heijst (Nijmegen, The Netherlands); S. Lipitz (Tel Hashomer, Israel).
D005260:Female; D005865:Gestational Age; D006257:Head / Q000196:embryology*; D006548:Hernia, Diaphragmatic / Q000196:embryology / Q000401:mortality; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D007231:Infant, Newborn; D008168:Lung / Q000196:embryology*; D011237:Predictive Value of Tests; D011247:Pregnancy; D011296:Prenatal Diagnosis; D012044:Regression Analysis; D016019:Survival Analysis