title: Fetal Stomach Position Predicts Neonatal Outcomes in Isolated Left-Sided Congenital Diaphragmatic Hernia.
abstract: BACKGROUND
  We sought to determine the relationship between the degree of stomach herniation by antenatal sonography and neonatal outcomes in fetuses with isolated left-sided congenital diaphragmatic hernia (CDH).
  
  
  METHODS
  We retrospectively reviewed neonatal medical records and antenatal sonography of fetuses with isolated left CDH cared for at a single institution (2000-2012). Fetal stomach position was classified on sonography as follows: intra-abdominal, anterior left chest, mid-to-posterior left chest, or retrocardiac (right chest).
  
  
  RESULTS
  Ninety fetuses were included with 70% surviving to neonatal discharge. Stomach position was intra-abdominal in 14% (n = 13), anterior left chest in 19% (n = 17), mid-to-posterior left chest in 41% (n = 37), and retrocardiac in 26% (n = 23). Increasingly abnormal stomach position was linearly associated with an increased odds of death (OR 4.8, 95% CI 2.1-10.9), extracorporeal membrane oxygenation (ECMO; OR 5.6, 95% CI 1.9-16.7), nonprimary diaphragmatic repair (OR 2.7, 95% CI 1.4-5.5), prolonged mechanical ventilation (OR 5.9, 95% CI 2.3-15.6), and prolonged respiratory support (OR 4.0, 95% CI 1.6-9.9). All fetuses with intra-abdominal stomach position survived without substantial respiratory morbidity or need for ECMO.
  
  
  CONCLUSIONS
  Fetal stomach position is strongly associated with neonatal outcomes in isolated left CDH. This objective tool may allow for accurate prognostication in a variety of clinical settings.
authors.affiliation: Department of Diagnostic Radiology, Oregon Health and Science University, Portland, Oreg., USA.
authors.forename: Amaya M
authors.initials: AM
authors.lastname: Basta
authors.forename: Leslie A
authors.initials: LA
authors.lastname: Lusk
authors.forename: Roberta L
authors.initials: RL
authors.lastname: Keller
authors.forename: Roy A
authors.initials: RA
authors.lastname: Filly
mesh_terms: D000328:Adult; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D065630:Hernias, Diaphragmatic, Congenital / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D011247:Pregnancy; D011379:Prognosis; D012121:Respiration, Artificial; D012189:Retrospective Studies; D013270:Stomach / Q000000981:diagnostic imaging* / Q000196:embryology; D016019:Survival Analysis; D016896:Treatment Outcome