PDF herunterladen
Am J Perinatol 2018; 35(10): 919-924
DOI: 10.1055/s-0037-1617754
SMFM Fellowship Series Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Prenatal Diagnosis of Congenital Diaphragmatic Hernia: Does Laterality Predict Perinatal Outcomes?

Jeffrey D. Sperling
1   Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, California
2   Department of Pediatrics, University of California, San Francisco, San Francisco, California
,
Teresa N. Sparks
1   Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, California
2   Department of Pediatrics, University of California, San Francisco, San Francisco, California
,
Victoria K. Berger
1   Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, California
2   Department of Pediatrics, University of California, San Francisco, San Francisco, California
,
Jody A. Farrell
3   Division of Pediatric Surgery, Department of Surgery, Fetal Treatment Center, University of California, San Francisco, San Francisco, California
,
Kristen Gosnell
3   Division of Pediatric Surgery, Department of Surgery, Fetal Treatment Center, University of California, San Francisco, San Francisco, California
,
Roberta L. Keller
2   Department of Pediatrics, University of California, San Francisco, San Francisco, California
,
Mary E. Norton
1   Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, California
2   Department of Pediatrics, University of California, San Francisco, San Francisco, California
,
Juan M. Gonzalez
1   Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, California
2   Department of Pediatrics, University of California, San Francisco, San Francisco, California
› Institutsangaben
Weitere Informationen

Publikationsverlauf

04. Juli 2017

29. November 2017

Publikationsdatum:
05. Januar 2018 (online)

    Lizenzen und Reprints

Abstract

Objective The objective of this study was to examine laterality as a predictor of outcomes among fetuses with prenatally diagnosed congenital diaphragmatic hernia (CDH).

Methods This is a retrospective cohort study of pregnancies with CDH evaluated at our center from 2008 to 2016 compared cases with right-sided CDH (RCDH) versus left-sided CDH (LCDH). The primary outcome was survival to discharge. Secondary outcomes included ultrasound predictors of poor prognosis (liver herniation, stomach herniation, lung area-to-head circumference ratio [LHR]), concurrent anomalies, hydrops, stillbirth, preterm birth, mode of delivery, small for gestational age, use of extracorporeal membrane oxygenation, and length of stay. Terminations and stillbirths were excluded from analyses of neonatal outcomes.

Results In this study, 157 (83%) LCDH and 32 (17%) RCDH cases were identified. Survival to discharge was similar (64 vs. 66.4%, p = 0.49) with regard to laterality. RCDH had higher rates of liver herniation (90.6 vs. 72%, p = 0.03), hydrops fetalis (15.6 vs. 1.3%, p < 0.01), and lower LHR (0.87 vs. 0.99, p = 0.04). LCDH had higher rates of stomach herniation (69.4 vs. 12.5%, p < 0.01). Rates of other outcomes were similar in univariate analyses. Adjusting for microarray abnormalities, the odds for survival to discharge for RCDH compared with LCDH was 0.93 (0.38–2.30, p = 0.88).

Conclusion Compared with LCDH, fetuses with RCDH had higher rates of adverse ultrasound predictors, but equivalent survival.

Keywords

congenital diaphragmatic hernia - prenatal diagnosis - fetal - laterality - LHR - ECMO - EXIT
 

  • References

  • 1 McGivern MR, Best KE, Rankin J. , et al. Epidemiology of congenital diaphragmatic hernia in Europe: a register-based study. Arch Dis Child Fetal Neonatal Ed 2015; 100 (02) F137-F144
    CrossrefPubMedGoogle Scholar
  • 2 Deprest J, Brady P, Nicolaides K. , et al. Prenatal management of the fetus with isolated congenital diaphragmatic hernia in the era of the TOTAL trial. Semin Fetal Neonatal Med 2014; 19 (06) 338-348
    CrossrefPubMedGoogle Scholar
  • 3 Bloss RS, Aranda JV, Beardmore HE. Congenital diaphragmatic hernia: pathophysiology and pharmacologic support. Surgery 1981; 89 (04) 518-524
    PubMedGoogle Scholar
  • 4 Logan JW, Rice HE, Goldberg RN, Cotten CM. Congenital diaphragmatic hernia: a systematic review and summary of best-evidence practice strategies. J Perinatol 2007; 27 (09) 535-549
    CrossrefPubMedGoogle Scholar
  • 5 Mullassery D, Ba'ath ME, Jesudason EC, Losty PD. Value of liver herniation in prediction of outcome in fetal congenital diaphragmatic hernia: a systematic review and meta-analysis. Ultrasound Obstet Gynecol 2010; 35 (05) 609-614
    CrossrefPubMedGoogle Scholar
  • 6 Lusk LA, Wai KC, Moon-Grady AJ, Basta AM, Filly R, Keller RL. Fetal ultrasound markers of severity predict resolution of pulmonary hypertension in congenital diaphragmatic hernia. Am J Obstet Gynecol 2015; 213 (02) 216.e1-216.e8
    CrossrefPubMedGoogle Scholar
  • 7 Büsing KA, Kilian AK, Schaible T, Endler C, Schaffelder R, Neff KW. MR relative fetal lung volume in congenital diaphragmatic hernia: survival and need for extracorporeal membrane oxygenation. Radiology 2008; 248 (01) 240-246
    CrossrefPubMedGoogle Scholar
  • 8 Datin-Dorriere V, Rouzies S, Taupin P. , et al. Prenatal prognosis in isolated congenital diaphragmatic hernia. Am J Obstet Gynecol 2008; 198 (01) 80.e1-80.e5
    CrossrefPubMedGoogle Scholar
  • 9 Paek BW, Coakley FV, Lu Y. , et al. Congenital diaphragmatic hernia: prenatal evaluation with MR lung volumetry--preliminary experience. Radiology 2001; 220 (01) 63-67
    CrossrefPubMedGoogle Scholar
  • 10 Mahieu-Caputo D, Sonigo P, Dommergues M. , et al. Fetal lung volume measurement by magnetic resonance imaging in congenital diaphragmatic hernia. BJOG 2001; 108 (08) 863-868
    PubMedGoogle Scholar
  • 11 Gorincour G, Bouvenot J, Mourot MG. , et al; Groupe Radiopédiatrique de Recherche en Imagerie Foetale (GRRIF). Prenatal prognosis of congenital diaphragmatic hernia using magnetic resonance imaging measurement of fetal lung volume. Ultrasound Obstet Gynecol 2005; 26 (07) 738-744
    CrossrefPubMedGoogle Scholar
  • 12 Bonfils M, Emeriaud G, Durand C. , et al. Fetal lung volume in congenital diaphragmatic hernia. Arch Dis Child Fetal Neonatal Ed 2006; 91 (05) F363-F364
    CrossrefPubMedGoogle Scholar
  • 13 Victoria T, Bebbington MW, Danzer E. , et al. Use of magnetic resonance imaging in prenatal prognosis of the fetus with isolated left congenital diaphragmatic hernia. Prenat Diagn 2012; 32 (08) 715-723
    CrossrefPubMedGoogle Scholar
  • 14 Sbragia L, Paek BW, Filly RA. , et al. Congenital diaphragmatic hernia without herniation of the liver: does the lung-to-head ratio predict survival?. J Ultrasound Med 2000; 19 (12) 845-848
    CrossrefPubMedGoogle Scholar
  • 15 Jani J, Nicolaides KH, Keller RL. , et al; Antenatal-CDH-Registry Group. Observed to expected lung area to head circumference ratio in the prediction of survival in fetuses with isolated diaphragmatic hernia. Ultrasound Obstet Gynecol 2007; 30 (01) 67-71
    CrossrefPubMedGoogle Scholar
  • 16 Mayer S, Klaritsch P, Petersen S. , et al. The correlation between lung volume and liver herniation measurements by fetal MRI in isolated congenital diaphragmatic hernia: a systematic review and meta-analysis of observational studies. Prenat Diagn 2011; 31 (11) 1086-1096
    CrossrefPubMedGoogle Scholar
  • 17 DeKoninck P, Gomez O, Sandaite I. , et al. Right-sided congenital diaphragmatic hernia in a decade of fetal surgery. BJOG 2015; 122 (07) 940-946
    CrossrefPubMedGoogle Scholar
  • 18 Dott MM, Wong LYC, Rasmussen SA. Population-based study of congenital diaphragmatic hernia: risk factors and survival in Metropolitan Atlanta, 1968-1999. Birth Defects Res A Clin Mol Teratol 2003; 67 (04) 261-267
    CrossrefPubMedGoogle Scholar
  • 19 Torfs CP, Curry CJ, Bateson TF, Honoré LH. A population-based study of congenital diaphragmatic hernia. Teratology 1992; 46 (06) 555-565
    CrossrefPubMedGoogle Scholar
  • 20 Fisher JC, Jefferson RA, Arkovitz MS, Stolar CJ. Redefining outcomes in right congenital diaphragmatic hernia. J Pediatr Surg 2008; 43 (02) 373-379
    CrossrefPubMedGoogle Scholar
  • 21 Hedrick HL, Crombleholme TM, Flake AW. , et al. Right congenital diaphragmatic hernia: prenatal assessment and outcome. J Pediatr Surg 2004; 39 (03) 319-323
    CrossrefPubMedGoogle Scholar
  • 22 Partridge EA, Peranteau WH, Herkert L. , et al. Right- versus left-sided congenital diaphragmatic hernia: a comparative outcomes analysis. J Pediatr Surg 2016; 51 (06) 900-902
    CrossrefPubMedGoogle Scholar
  • 23 Collin M, Trinder S, Minutillo C, Rao S, Dickinson J, Samnakay N. A modern era comparison of right versus left sided congenital diaphragmatic hernia outcomes. J Pediatr Surg 2016; 51 (09) 1409-1413
    CrossrefPubMedGoogle Scholar
  • 24 Akinkuotu AC, Cruz SM, Cass DL. , et al. Revisiting outcomes of right congenital diaphragmatic hernia. J Surg Res 2015; 198 (02) 413-417
    CrossrefPubMedGoogle Scholar
  • 25 Beaumier CK, Beres AL, Puligandla PS, Skarsgard ED. ; Canadian Pediatric Surgery Network. Clinical characteristics and outcomes of patients with right congenital diaphragmatic hernia: a population-based study. J Pediatr Surg 2015; 50 (05) 731-733
    CrossrefPubMedGoogle Scholar
  • 26 Wynn J, Krishnan U, Aspelund G. , et al. Outcomes of congenital diaphragmatic hernia in the modern era of management. J Pediatr 2013; 163 (01) 114-9.e1
    CrossrefPubMedGoogle Scholar
  • 27 Jani JC, Peralta CF, Nicolaides KH. Lung-to-head ratio: a need to unify the technique. Ultrasound Obstet Gynecol 2012; 39 (01) 2-6
    CrossrefPubMedGoogle Scholar
  • 28 Jani JC, Benachi A, Nicolaides KH. , et al; Antenatal-CDH-Registry group. Prenatal prediction of neonatal morbidity in survivors with congenital diaphragmatic hernia: a multicenter study. Ultrasound Obstet Gynecol 2009; 33 (01) 64-69
    CrossrefPubMedGoogle Scholar
  • 29 Yang SH, Nobuhara KK, Keller RL. , et al. Reliability of the lung-to-head ratio as a predictor of outcome in fetuses with isolated left congenital diaphragmatic hernia at gestation outside 24-26 weeks. Am J Obstet Gynecol 2007; 197 (01) 30.e1-30.e7
    CrossrefPubMedGoogle Scholar
  • 30 Metkus AP, Filly RA, Stringer MD, Harrison MR, Adzick NS. Sonographic predictors of survival in fetal diaphragmatic hernia. J Pediatr Surg 1996; 31 (01) 148-151 , discussion 151–152
    CrossrefPubMedGoogle Scholar
  • 31 Sener T, Ozalp S, Hassa H, Zeytinoglu S, Basaran N, Durak B. Ultrasonographic detection of single umbilical artery: a simple marker of fetal anomaly. Int J Gynaecol Obstet 1997; 58 (02) 217-221
    CrossrefPubMedGoogle Scholar
  • 32 Laye MR, Rehberg JF, Kosek MA, Bufkin LK, Bofill JA. Prenatal diagnoses and outcomes of congenital diaphragmatic hernia. J Miss State Med Assoc 2007; 48 (03) 67-71
    PubMedGoogle Scholar
  • 33 Bianco K, Feldstein V, Norton M, Farrell J, Keller R. OP04. 08: the prognostic significance of a single umbilical artery (SUA) in fetuses with prenatally detected congenital diaphragmatic hernia (CDH). Ultrasound Obstet Gynecol 2011; 38 (S1): 68
    PubMedGoogle Scholar
  • 34 Goodfellow T, Hyde I, Burge DM, Freeman NV. Congenital diaphragmatic hernia: the prognostic significance of the site of the stomach. Br J Radiol 1987; 60 (718) 993-995
    CrossrefPubMedGoogle Scholar
  • 35 Burge DM, Atwell JD, Freeman NV. Could the stomach site help predict outcome in babies with left sided congenital diaphragmatic hernia diagnosed antenatally?. J Pediatr Surg 1989; 24 (06) 567-569
    CrossrefPubMedGoogle Scholar
  • 36 Hatch Jr EI, Kendall J, Blumhagen J. Stomach position as an in utero predictor of neonatal outcome in left-sided diaphragmatic hernia. J Pediatr Surg 1992; 27 (06) 778-779
    CrossrefPubMedGoogle Scholar
  • 37 Kitano Y, Okuyama H, Saito M. , et al. Re-evaluation of stomach position as a simple prognostic factor in fetal left congenital diaphragmatic hernia: a multicenter survey in Japan. Ultrasound Obstet Gynecol 2011; 37 (03) 277-282
    CrossrefPubMedGoogle Scholar
  • 38 Zamora IJ, Olutoye OO, Cass DL. , et al. Prenatal MRI fetal lung volumes and percent liver herniation predict pulmonary morbidity in congenital diaphragmatic hernia (CDH). J Pediatr Surg 2014; 49 (05) 688-693
    CrossrefPubMedGoogle Scholar
  • 39 Ruano R, Lazar DA, Cass DL. , et al. Fetal lung volume and quantification of liver herniation by magnetic resonance imaging in isolated congenital diaphragmatic hernia. Ultrasound Obstet Gynecol 2014; 43 (06) 662-669
    CrossrefPubMedGoogle Scholar
  • 40 Ruano R, Takashi E, da Silva MM, Campos JA, Tannuri U, Zugaib M. Prediction and probability of neonatal outcome in isolated congenital diaphragmatic hernia using multiple ultrasound parameters. Ultrasound Obstet Gynecol 2012; 39 (01) 42-49
    CrossrefPubMedGoogle Scholar
  • 41 Peralta CF, Cavoretto P, Csapo B, Vandecruys H, Nicolaides KH. Assessment of lung area in normal fetuses at 12-32 weeks. Ultrasound Obstet Gynecol 2005; 26 (07) 718-724
    CrossrefPubMedGoogle Scholar
  • 42 Van Mieghem T, Cruz-Martinez R, Allegaert K. , et al. Outcome of fetuses with congenital diaphragmatic hernia and associated intrafetal fluid effusions managed in the era of fetal surgery. Ultrasound Obstet Gynecol 2012; 39 (01) 50-55
    CrossrefPubMedGoogle Scholar
  • 43 Norton ME, Chauhan SP, Dashe JS. ; Society for Maternal-Fetal Medicine (SMFM). Society for Maternal-Fetal Medicine (SMFM) clinical guideline #7: nonimmune hydrops fetalis. Am J Obstet Gynecol 2015; 212 (02) 127-139
    CrossrefPubMedGoogle Scholar
  • 44 Shojai R, Gire C, Chaumoître K. , et al. Right diaphragmatic hernia and hydrops: is it always fatal?. Ultrasound Obstet Gynecol 2004; 24 (07) 803-804
    CrossrefPubMedGoogle Scholar
  • 45 Derderian SC, Iqbal CW, Ganzalez JM, MacKenzie TC, Miniati D, Hirose S. Thoracoamniotic shunt placement for a right-sided congenital diaphragmatic hernia complicated by hydrops. J Pediatr Surg Case Rep 2013; 1 (09) 281-283
    PubMedGoogle Scholar
  • 46 Bancalari E. The Newborn Lung: Neonatology Questions and Controversies. Elsevier Health Sciences; 2012
    Google Scholar
  • 47 Zaiss I, Kehl S, Link K. , et al. Associated malformations in congenital diaphragmatic hernia. Am J Perinatol 2011; 28 (03) 211-218
    Artikel in Thieme ConnectPubMedGoogle Scholar