Perinatal management of congenital diaphragmatic hernia: when and how should babies be delivered? Results from the Canadian Pediatric Surgery Network.
OBJECTIVE
A prenatal diagnosis of congenital diaphragmatic hernia (CDH) enables therapeutic decision making during the intrapartum period. This study seeks to identify the gestational age and delivery mode associated with optimal outcomes.


METHODS
A national data set was used to study CDH babies born between 2005 and 2009. The primary outcome was survival to discharge. Primary and secondary outcomes were analyzed by categorical gestational age (preterm, <37 weeks; early term, 37-38 weeks; late term, >39 weeks) by intended and actual route of delivery and by birth plan conformity, regardless of route.


RESULTS
Of 214 live born babies (gestational age, 37.6 ± 4.0 weeks; birth weight, 3064 ± 696 g), 143 (66.8%) had a prenatal diagnosis and 174 (81.3%) survived to discharge. Among 143 prenatally diagnosed pregnancies, 122 (85.3%) underwent abdominal delivery (AD) and 21 (14.6%) underwent cesarean delivery (CS). Conformity between intended and actual delivery occurred in 119 (83.2%). Neither categorical gestational age nor delivery route influenced outcome. Although babies delivered by planned CS had a lower mortality than those delivered by planned AD (2/21 and 36/122, respectively; P = .04), this difference was not significant by multivariate analysis. Conformity to any birth plan was associated with a trend toward improved survival.


CONCLUSIONS
Our data do not support advocacy of any specific delivery plan or route nor optimal gestational age for prenatally diagnosed CDH.
Department of Surgery, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
Arash
A
Safavi
Yi
Y
Lin
Erik D
ED
Skarsgard
D001724:Birth Weight; D002170:Canada; D002585:Cesarean Section / Q000706:statistics & numerical data; D016208:Databases, Factual; D036861:Delivery, Obstetric / Q000379:methods; D017558:Elective Surgical Procedures / Q000706:statistics & numerical data; D057286:Electronic Health Records; D004750:Enteral Nutrition / Q000706:statistics & numerical data; D015199:Extracorporeal Membrane Oxygenation / Q000706:statistics & numerical data; D005260:Female; D005865:Gestational Age; D006548:Hernia, Diaphragmatic / Q000175:diagnosis / Q000401:mortality; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D007231:Infant, Newborn; D007255:Information Services; D007902:Length of Stay; D018743:Perinatal Care; D011247:Pregnancy; D011296:Prenatal Diagnosis; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D016896:Treatment Outcome