title: Hernia Sac Presence Portends Better Survivability of Isolated Congenital Diaphragmatic Hernia with "Liver-Up".
abstract: ObjectiveThe objective of this study was to investigate the prognostic value of a hernia sac in isolated congenital diaphragmatic hernia (CDH) with intrathoracic liver herniation ("liver-up").Study DesignA retrospective study from the single tertiary center. Isolated "liver-up" CDH neonates referred to our institution between 2000 and 2015 were reviewed for the presence or absence of a hernia sac. Association between the presence of a hernia sac and survival was assessed.ResultsOver the study period, there were 29 isolated CDH patients with "liver-up" who were treated, 7 (24%) had a sac, and 22 (76%) did not. Demographics were similar between groups. However, disease acuity, assessed from lower Apgar scores (p= 0.044), lower probability of survival (p= 0.037), and lower admission oxygenation (p= 0.027), was higher in neonates without a sac. Hospital survival was significantly higher for those with sac compared with those without (7/7, 100 vs. 7/22, 32%,p= 0.002).ConclusionThe presence of a hernia sac may be associated with better survival for isolated "liver-up" CDH. As the presence of sac can be prenatally detected, it may be a useful marker to aid perinatal decision making.
authors: Department of Pediatrics, Neonatal Intensive Care Unit, University Hospital Centre Zagreb, University of Zagreb, School of Medicine, Zagreb, Croatia.
authors: Ruža
authors: R
authors: Grizelj
authors: Division of Neonatology, Department of Obstetrics and Gynecology, University Hospital Merkur, Zagreb, Croatia.
authors: Katarina
authors: K
authors: Bojanić
authors: Department of Pediatrics, Division of Gastroenterology, University Hospital Centre Zagreb, University of Zagreb, School of Medicine, Zagreb, Croatia.
authors: Jurica
authors: J
authors: Vuković
authors: Department of Pediatrics, Pediatric Intensive Care Unit, University Hospital Centre Zagreb, University of Zagreb, School of Medicine, Zagreb, Croatia.
authors: Milivoj
authors: M
authors: Novak
authors: Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota.
authors: Toby N
authors: TN
authors: Weingarten
authors: Division of Biomedical Statistics and Informatics, Department of Statistics, Mayo Clinic, Rochester, Minnesota.
authors: Darrell R
authors: DR
authors: Schroeder
authors: Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota.
authors: Juraj
authors: J
authors: Sprung
mesh_terms: D001034:Apgar Score; D005260:Female; D065630:Hernias, Diaphragmatic, Congenital / Q000401:mortality* / Q000473:pathology*; D006801:Humans; D007231:Infant, Newborn; D008099:Liver / Q000473:pathology*; D008297:Male; D010100:Oxygen / Q000097:blood; D062072:Patient Acuity; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate
chemical_list: D010100:Oxygen