Hernia Sac Presence Portends Better Survivability of Isolated Congenital Diaphragmatic Hernia with “Liver-Up”

Ruža Grizelj; Katarina Bojanić; Jurica Vuković; Milivoj Novak; Toby N. Weingarten; Darrell R. Schroeder; Juraj Sprung

doi:10.1055/s-0036-1593765

American Journal of Perinatology, Inhaltsverzeichnis

Am J Perinatol 2017; 34(05): 515-519
DOI: 10.1055/s-0036-1593765

Rapid Communication

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Hernia Sac Presence Portends Better Survivability of Isolated Congenital Diaphragmatic Hernia with “Liver-Up”

Ruža Grizelj^*

¹Department of Pediatrics, Neonatal Intensive Care Unit, University Hospital Centre Zagreb, University of Zagreb, School of Medicine, Zagreb, Croatia

,

Katarina Bojanić^*

²Division of Neonatology, Department of Obstetrics and Gynecology, University Hospital Merkur, Zagreb, Croatia

,

Jurica Vuković

³Department of Pediatrics, Division of Gastroenterology, University Hospital Centre Zagreb, University of Zagreb, School of Medicine, Zagreb, Croatia

,

Milivoj Novak

⁴Department of Pediatrics, Pediatric Intensive Care Unit, University Hospital Centre Zagreb, University of Zagreb, School of Medicine, Zagreb, Croatia

,

Toby N. Weingarten

⁵Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota

,

Darrell R. Schroeder

⁶Division of Biomedical Statistics and Informatics, Department of Statistics, Mayo Clinic, Rochester, Minnesota

,

Juraj Sprung

⁵Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota

› Institutsangaben

Abstract

Objective The 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 Design A 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.

Results Over 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).

Conclusion The 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.

Keywords

congenital diaphragmatic hernia - hernia sac - liver-up - mortality - outcome - risk assessment - survival

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Referenzen

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