title: Antenatal assessment of liver position, rather than lung-to-head ratio (LHR) or observed/expected LHR, is predictive of outcome in fetuses with isolated left-sided congenital diaphragmatic hernia.
abstract: OBJECTIVE
  Respiratory morbidity in congenital diaphragmatic hernia (CDH) is associated with high mortality and adverse outcome. Accurate prenatal diagnosis is essential for prognosis and potential treatment in utero. The aim was to evaluate the prenatal ultrasound findings in assessing the respiratory prognosis in fetuses with isolated left-sided CDH.
  
  
  METHODS
  We retrospectively analyzed the medical records of 59 prenatally diagnosed left-sided CDH cases managed at a tertiary perinatal center.
  
  
  RESULTS
  Survival rate in the study group was 73% (43/59). We found no statistically significant relationship between survival and the presence of polyhydramnios, gestational age at diagnosis, lung-to-head ratio (LHR) and observed/expected LHR (O/E LHR) values, gestational age at birth and birth weight. Intrathoracic liver herniation was a statistically significant parameter adversely affecting survival (37.2% in survivors, 68.8% in non-survivors, p = 0.031) and logistic regression confirmed this relationship. The presence of pneumothorax and severe pulmonary hypertension were significantly associated with mortality (82% non-survivors versus 15% in survivors, p = 0.0001).
  
  
  CONCLUSIONS
  Intrathoracic liver herniation seems to be a reliable parameter in the prediction of survival and neonatal respiratory morbidity in fetuses with isolated left-sided CDH. In contrast, we found no significant correlation between perinatal outcome and LHR, O/E LHR values, birth weight and gestational age.
authors.affiliation: a Third Faculty of Medicine, Charles University , Prague , Czech Republic.|b Fetal Medicine Centre, Institute for the Care of Mother and Child , Prague , Czech Republic , and.
authors.forename: Zbyněk
authors.initials: Z
authors.lastname: Straňák
authors.affiliation: a Third Faculty of Medicine, Charles University , Prague , Czech Republic.|b Fetal Medicine Centre, Institute for the Care of Mother and Child , Prague , Czech Republic , and.
authors.forename: Ladislav
authors.initials: L
authors.lastname: Krofta
authors.affiliation: a Third Faculty of Medicine, Charles University , Prague , Czech Republic.|b Fetal Medicine Centre, Institute for the Care of Mother and Child , Prague , Czech Republic , and.
authors.forename: Lucia Anna
authors.initials: LA
authors.lastname: Haak
authors.affiliation: b Fetal Medicine Centre, Institute for the Care of Mother and Child , Prague , Czech Republic , and.
authors.forename: Jiří
authors.initials: J
authors.lastname: Vojtěch
authors.affiliation: b Fetal Medicine Centre, Institute for the Care of Mother and Child , Prague , Czech Republic , and.
authors.forename: Luboš
authors.initials: L
authors.lastname: Hašlík
authors.affiliation: c Department of Pediatric Surgery , Second Faculty of Medicine , Prague , Czech Republic.
authors.forename: Michal
authors.initials: M
authors.lastname: Rygl
authors.affiliation: c Department of Pediatric Surgery , Second Faculty of Medicine , Prague , Czech Republic.
authors.forename: Karel
authors.initials: K
authors.lastname: Pýcha
authors.affiliation: a Third Faculty of Medicine, Charles University , Prague , Czech Republic.|b Fetal Medicine Centre, Institute for the Care of Mother and Child , Prague , Czech Republic , and.
authors.forename: Jaroslav
authors.initials: J
authors.lastname: Feyereisl
mesh_terms: D005260:Female; D005865:Gestational Age; D006257:Head / Q000000981:diagnostic imaging / Q000196:embryology*; D065630:Hernias, Diaphragmatic, Congenital / Q000175:diagnosis* / Q000196:embryology / Q000401:mortality; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging / Q000196:embryology*; D016015:Logistic Models; D008168:Lung / Q000000981:diagnostic imaging / Q000196:embryology*; D011247:Pregnancy; D011379:Prognosis; D012189:Retrospective Studies; D016216:Ultrasonography, Prenatal
keywords: Congenital diaphragmatic hernia; outcome; prenatal diagnosis; respiratory morbidity