• Holly L Hedrick, Enrico Danzer, Aziz Merchant, Michael W Bebbington, Huaqing Zhao, Alan W Flake, Mark P Johnson, Kenneth W Liechty, Lori J Howell, R Douglas Wilson, and N Scott Adzick.
• Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
• Am. J. Obstet. Gynecol. 2007 Oct 1; 197 (4): 422.e1-4.

ObjectiveThe purpose of this study was to determine the ability of liver position and lung-to-head ratio to predict outcome in isolated left congenital diaphragmatic hernia.Study DesignWe reviewed prenatal studies and postnatal outcomes of congenital diaphragmatic hernia between January 1996 and January 2006.ResultsEighty-nine patients received prenatal and postnatal care at 1 institution. In fetuses with liver up, extracorporeal membrane oxygenation was required in 39 of 49 fetuses (80%), compared with 10 of 40 fetuses (25%) for those with liver down (P < .0001). Overall survival rate was 45%, compared with 93% for those with liver down (P < .00005). Low lung-to-head ratio (<1.0) predicted increased incidence of extracorporeal membrane oxygenation (75%; P = .036) and lower survival (35%; P = .0003). However, when measured at <24 weeks of gestation, lung-to-head ratio was not predictive of outcome (extracorporeal membrane oxygenation, P = .108; survival, P = .150); liver position remained highly predictive (extracorporeal membrane oxygenation, P = .006; survival, P = .001).ConclusionLiver position is the best prenatal predictor of outcome in isolated left congenital diaphragmatic hernia. Lung-to-head ratio alone should not be used to counsel families regarding mid gestational management choices.

29 keywords...

hide…