Revisiting outcomes of right congenital diaphragmatic hernia.
BACKGROUND
Studies comparing outcomes of right- and left-sided congenital diaphragmatic hernia (R-CDH and L-CDH) have yielded conflicting results. We hypothesized that R-CDH is associated with higher short-term pulmonary morbidity than L-CDH.


METHODS
We reviewed all CDH patients at a tertiary children's hospital over 10 y. In prenatally diagnosed CDH, the observed-to-expected total fetal lung volume and percentage liver herniation (%LH) were calculated using fetal magnetic resonance imaging-based measurements. Outcomes were compared in patients with isolated CDH. Patients were subsequently matched by %LH to compare outcomes.


RESULTS
Of 189 CDH patients, 37 (20.1 %) were R-CDH and 147 (79.9%) were L-CDH. Those with R-CDH were prenatally diagnosed at a significantly lower rate (40.5% versus 73.5%; P < 0.001) and later gestational age (26.5 ± 7.7 versus 22.6 ± 5.65 wk; P = 0.062). There was no difference in observed-to-expected total fetal lung volume between those with R-CDH and L-CDH (30.2 ± 11.1% versus 33.1 ± 14.2%; P = 0.471). Fetuses with R-CDH had a higher %LH than those with L-CDH (37.5 ± 14.1% versus 18.6 ± 12.2%; P < 0.001). Patients with isolated R-CDH had a higher need for extracorporeal membrane oxygenation than L-CDH (48% versus 27%; P = 0.055). There was no difference in duration of tracheal intubation, hospital stay, need for supplemental oxygen at 30-d of life or 6-mo mortality between groups. There was no difference in mortality and pulmonary morbidity when patients were matched by %LH.


CONCLUSIONS
Compared to those with L-CDH, fetuses with R-CDH are less likely to be diagnosed prenatally and have a higher need for extracorporeal membrane oxygenation. The sidedness of the hernia defect was not associated with differences in short-term pulmonary morbidity in this large, contemporary single-institution experience of neonates with CDH.
Texas Children's Fetal Center and the Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.
Adesola C
AC
Akinkuotu
Texas Children's Fetal Center and the Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.
Stephanie M
SM
Cruz
Texas Children's Fetal Center and the Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas; Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas.
Darrell L
DL
Cass
Department of Radiology, Baylor College of Medicine, Houston, Texas.
Christopher I
CI
Cassady
Department of Radiology, Baylor College of Medicine, Houston, Texas.
Amy R
AR
Mehollin-Ray
Department of Radiology, Baylor College of Medicine, Houston, Texas.
Jennifer L
JL
Williams
Texas Children's Fetal Center and the Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.
Timothy C
TC
Lee
Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas.
Rodrigo
R
Ruano
Department of Pediatrics - Newborn Section, Baylor College of Medicine, Houston, Texas.
Stephen E
SE
Welty
Texas Children's Fetal Center and the Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas; Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas. Electronic address: oolutoye@bcm.tmc.edu.
Oluyinka O
OO
Olutoye
D015199:Extracorporeal Membrane Oxygenation / Q000706:statistics & numerical data; D065630:Hernias, Diaphragmatic, Congenital / Q000453:epidemiology / Q000473:pathology / Q000628:therapy*; D006801:Humans; D007231:Infant, Newborn; D008099:Liver / Q000473:pathology; D012189:Retrospective Studies; D013781:Texas / Q000453:epidemiology; D016896:Treatment Outcome
Liver herniation; Right congenital diaphragmatic hernia