Prenatal prognosis in isolated congenital diaphragmatic hernia.
OBJECTIVE
A monocentric retrospective study of 79 neonates with isolated diaphragmatic hernia antenatally diagnosed was performed to identify prenatal parameters that may characterize the severity of the disease.


METHODS
Postnatal treatment protocol included early high frequency ventilation, inhaled nitric oxide, and delayed surgery. Postnatal survival rate was 63.3%.


RESULTS
Age at diagnosis, polyhydramnios, and left ventricle/right ventricle index were not related with survival. None of the 9 left diaphragmatic hernias with intraabdominal stomach died. Neonatal mortality was significantly related with the side of the defect, intrathoracic position of the liver, the ratio of fetal lung area to head circumference value, and fetal lung volume ratio measured by resonance magnetic imaging.


CONCLUSIONS
No prenatal factor alone firmly predicts neonatal outcome. Clinicians should help stratify the severity of the disease and compare accurately different postnatal therapeutic strategies.
Datin-Dorriere
Valérie
V
Department of Pediatrics, Université Paris-Descartes, Faculté de Médecine, AP-HP, Hôpital Necker-Enfants Malades, Paris, France.
Rouzies
Sarah
S
Taupin
Pierre
P
Walter-Nicolet
Elizabeth
E
Benachi
Alexandra
A
Sonigo
Pascale
P
Mitanchez
Delphine
D
D002423:Cause of Death; D015331:Cohort Studies; D003131:Combined Modality Therapy; D005260:Female; D005865:Gestational Age; D006548:Hernia, Diaphragmatic / Q000000981:diagnostic imaging* / Q000401:mortality* / Q000628:therapy; D065630:Hernias, Diaphragmatic, Congenital; D006612:High-Frequency Ventilation / Q000379:methods; D006801:Humans; D007231:Infant, Newborn; D008176:Lung Volume Measurements; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011247:Pregnancy; D011256:Pregnancy Outcome; D011296:Prenatal Diagnosis / Q000379:methods; D011336:Probability; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016019:Survival Analysis; D013908:Thoracotomy / Q000379:methods; D016216:Ultrasonography, Prenatal