Congenital diaphragmatic hernia, etiology and management, a 10-year analysis of a single center.
OBJECTIVE
To analyze congenital diaphragmatic hernia (CDH) during a 10-year period at the University of Kiel, from 1995 through 2004, in order to develop a strategy to improve prenatal diagnosis, to be able to consider endoscopical treatment for selected cases and to assess the current postnatal treatment strategies.


METHODS
Data were obtained from the fetal medicine ultrasound department, from the birth registry, from the postmortem registry, from the neonatal intensive care unit, from pediatric surgery and from the genetic database. Data were subselected for chromosomes, genetic syndromes, for isolated CDH and for associated anomalies, the lung to head ratio and lung volumes were assessed. Data were analyzed respectively for gestation at diagnosis, the type of CDH, the perinatal management and the postnatal outcome.


RESULTS
There were 29 cases of CDH, in 10/29 (34%) the parents requested termination of pregnancy of which two had already died during pregnancy, 12/19 (63%) survived, which was defined as discharge from the neonatal intensive care unit, seven newborns 7/19 (37%) died in the hospital, 5 of these 5/7 (71%) were delivered in Kiel. A prenatal diagnosis was performed in 16/29 (55%), 1/16 (6%), 7/16 (43%) and 8/16 (50%) in the 1st, 2nd and 3rd trimester, respectively; in 10/29 (34%) diagnosis was performed postpartum, in 3/29 (10%) the diagnosis was performed at autopsy following termination of pregnancy. When the liver was in the abdomen, 9/10 (90%) of the children survived, compared to only 3/8 (43%) when the liver was located in the thorax. A lung to head ratio of 0.81 at 24 weeks resulted in death due to pulmonary hypoplasia.


CONCLUSIONS
The overall survival in CDH is around 50%, antenatal endoscopical therapy may only be considered, if the diagnosis is performed in the early second trimester, and selection criteria such as the lung to head ratio, associated defects and the chromosomal status can be applied.
Department of Obstetrics and Gynecology, University of Schleswig-Holstein, Campus Kiel, Michaelisstrasse 16, Kiel, Germany.
Cornelia
C
Beck
Ozkan
O
Alkasi
Werner
W
Nikischin
Sylvia
S
Engler
Almut
A
Caliebe
Ivo
I
Leuschner
Constantin S
CS
von Kaisenberg
D000028:Abortion, Induced; D001344:Autopsy; D002887:Chromosomes, Human, Pair 18; D005260:Female; D005313:Fetal Death; D005858:Germany / Q000453:epidemiology; D006548:Hernia, Diaphragmatic / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D065630:Hernias, Diaphragmatic, Congenital; D017052:Hospital Mortality; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D007621:Karyotyping; D008099:Liver / Q000002:abnormalities; D008176:Lung Volume Measurements; D011247:Pregnancy; D011264:Pregnancy Trimesters; D011296:Prenatal Diagnosis; D014314:Trisomy