title: Congenital diaphragmatic hernia: does gestational age at diagnosis matter when evaluating morbidity and mortality?
abstract: OBJECTIVE
  The objective of the investigation was to study the relationship between gestational age at diagnosis and mortality and morbidity in fetuses with an isolated congenital diaphragmatic hernia.
  
  
  METHODS
  Between January 2008 and November 2013, 377 live births with isolated congenital diaphragmatic hernia diagnosed antenatally at a known gestational age were recorded in the database of the French National Center for Rare Diseases. The primary outcome studied was mortality estimated at 28 days and at 6 months. The secondary outcome was morbidity evaluated by pulmonary arterial hypertension at 48 hours, oxygen therapy dependence at 28 days, oral disorders, enteral feeding, and prosthetic patch repair. Analyses were adjusted for the main factors of congenital diaphragmatic hernia severity (side of the hernia, thoracic herniation of the liver, gestational age at birth, lung-to-head ratio, and prenatal treatment by tracheal occlusion.
  
  
  RESULTS
  Mortality rates at 28 days decreased significantly (P < .001) when gestational age at diagnosis increased: 61.1%, 39.2%, and 10.4% for a diagnosis in the first, second, and third trimester, respectively. Adjusted odds ratios were 3.12 [95% confidence interval, 1.86-5.25] and 0.35 [95% confidence interval, 0.18-0.66] for a diagnosis in the first and third trimesters, respectively, compared with a diagnosis in the second trimester. Similarly, morbidity decreased significantly when gestational age at diagnosis increased, and the trend remained significant after adjustment for the main factors of congenital diaphragmatic hernia severity (P < .001).
  
  
  CONCLUSIONS
  Gestational age at diagnosis is an independent predictor of postnatal prognosis for children presenting an isolated congenital diaphragmatic hernia and should be taken into account when estimating postnatal morbidity and mortality.
authors.affiliation: Center for Research in Epidemiology and Population Health, INSERM, Le Kremlin-Bicêtre, France; Université Paris-Sud, Le Kremlin-Bicêtre, France; Service de Gynécologie-Obstétrique, Hôpital Bicêtre, Le Kremlin-Bicêtre, France; Centre de Référence des Maladies Rares, Hernie de Coupole Diaphragmatique, France.
authors.forename: Hanane
authors.initials: H
authors.lastname: Bouchghoul
authors.affiliation: Center for Research in Epidemiology and Population Health, INSERM, Le Kremlin-Bicêtre, France; Université Paris-Sud, Le Kremlin-Bicêtre, France; Service de Gynécologie-Obstétrique, Hôpital Bicêtre, Le Kremlin-Bicêtre, France; Centre de Référence des Maladies Rares, Hernie de Coupole Diaphragmatique, France. Electronic address: marie-victoire.senat@bct.aphp.fr.
authors.forename: Marie-Victoire
authors.initials: MV
authors.lastname: Senat
authors.affiliation: Centre de Référence des Maladies Rares, Hernie de Coupole Diaphragmatique, France; Service de Néonatologie, Hôpital Jeanne de Flandre, Lille, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Storme
authors.affiliation: Centre de Référence des Maladies Rares, Hernie de Coupole Diaphragmatique, France; Service de Chirurgie Pédiatrique, Hôpital de la Timone, Marseille, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: de Lagausie
authors.affiliation: Centre de Référence des Maladies Rares, Hernie de Coupole Diaphragmatique, France; Service de Gynécologie-Obstétrique, Centre Hospitalier Universitaire, Montpellier, France.
authors.forename: Laetitia
authors.initials: L
authors.lastname: Begue
authors.affiliation: Centre de Référence des Maladies Rares, Hernie de Coupole Diaphragmatique, France; Service de Chirurgie Pédiatrique, Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants Malades, Paris, France.
authors.forename: Naziha
authors.initials: N
authors.lastname: Khen-Dunlop
authors.affiliation: Center for Research in Epidemiology and Population Health, INSERM, Le Kremlin-Bicêtre, France; Université Paris-Sud, Le Kremlin-Bicêtre, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Bouyer
authors.affiliation: Université Paris-Sud, Le Kremlin-Bicêtre, France; Centre de Référence des Maladies Rares, Hernie de Coupole Diaphragmatique, France; Service de Gynécologie-Obstétrique, Assistance Publique-Hôpitaux de Paris, Hôpital Antoine Béclère, Clamart, France.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Benachi
mesh_terms: D016208:Databases, Factual; D042241:Early Diagnosis; D004750:Enteral Nutrition / Q000706:statistics & numerical data; D005260:Female; D005865:Gestational Age; D065630:Hernias, Diaphragmatic, Congenital / Q000150:complications / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery; D059685:Herniorrhaphy; D006801:Humans; D006976:Hypertension, Pulmonary / Q000209:etiology; D007231:Infant, Newborn; D010102:Oxygen Inhalation Therapy / Q000706:statistics & numerical data; D010547:Persistent Fetal Circulation Syndrome / Q000209:etiology*; D011247:Pregnancy; D011379:Prognosis; D012131:Respiratory Insufficiency / Q000209:etiology / Q000628:therapy; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016216:Ultrasonography, Prenatal
keywords: congenital diaphragmatic hernia; first trimester; morbidity; mortality; prognosis