A Prospective Study of the Outcome for Fetuses With Diaphragmatic Hernia

Mr, Harrison; Ns, Adzick; Jm, Estes; Lj, Howell

doi:10.1001/jama.1994.03510290064038

Cited by 300 publications

(66 citation statements)

References 20 publications

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“…Nevertheless, in our series, rightsided lesion as well as major mediastinal shift and herni- ated liver were more frequently observed in neonates who died before 7 days of life, and these factors have also been related to a poorer outcome in other studies. 1,5,7,16 By analyzing the natural history of CDH, the present study is important for demonstrating that each hospital may experience different neonatal mortality rates in isolated CDH. It also motivates us to review our neonatal care and our prenatal evaluation of prognosis as well as to consider fetal interventions in selected cases.…”

Section: Discussionmentioning

confidence: 99%

“…4 Prenatal diagnosis has improved neonatal outcome worldwide through diagnosis of other associated malfor-mations, excluding chromosomal abnormalities, and planning delivery inside a specialized tertiary center. 5 Before the onset of prenatal sonographic diagnosis, the mortality rate was almost 100%, and CDH was considered a lethal malformation. 6 Nowadays, the mortality rate has been decreasing among neonates with isolated CDH, varying from 40% to 75% in developed countries.…”

Section: Introductionmentioning

confidence: 99%

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Prenatal Diagnosis and Perinatal Outcome of 38 Cases With Congenital Diaphragmatic Hernia: 8-Year Experience of a Tertiary Brazilian Center

Ruano

Bunduki

Silva

et al. 2006

Clinics

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diagnosis and perinatal outcome of 38 cases with congenital diaphragmatic hernia: 8-year experience of a tertiary Brazilian center. Clinics. 2006;61(3):197-202. PURPOSE:To evaluate the perinatal results for neonates with congenital diaphragmatic hernia diagnosed prenatally. METHOD: We reviewed data from 38 cases of congenital diaphragmatic hernia diagnosed prenatally from January 1995 to December 2003 in the Fetal Medicine Unit of the Department of Obstetrics and Gynecology, São Paulo University Medical School. The main data analyzed were gestational age at diagnosis, fetal karyotyping, side of diaphragmatic defect, presence of associated structural malformations, hepatic herniation, and severe mediastinal shift. Perinatal outcomes were obtained by reviewing hospital documents or by directly calling the patients' immediate relatives. RESULTS: Mean gestational age at diagnosis was 29 weeks (range, 16-37 weeks).Thirty (79%) cases had a left diaphragmatic defect and 8 (21%) had a right lesion. Associated structural malformations were observed in 21 (55%) cases, in which 12 fetuses had a normal karyotype and 9 had chromosomal abnormalities. Isolated congenital diaphragmatic hernia was confirmed in 17 (45%) cases. The overall perinatal mortality rate was 92%. Rates of fetal deaths, early neonatal deaths, late neonatal deaths, and survival were 42%, 50%, 0%, and 8%, respectively, in cases with associated structural malformations but normal karyotyping; 56%, 44%, 0%, and 0% for cases with chromosomal abnormalities; and, 0%, 76%, 12%, and 12% in cases with isolated congenital diaphragmatic hernia. The neonatal mortality rate was 89% in cases with isolated congenital diaphragmatic hernia. CONCLUSION: Perinatal mortality was very high in prenatally diagnosed cases of congenital diaphragmatic hernia. Earlier perinatal deaths are associated with the presence of other structural defects or chromosomal abnormalities. In cases of isolated congenital diaphragmatic hernia, mortality is related to the presence of herniated liver, right-sided lesion, and major mediastinal shift.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Prenatal Diagnosis and Perinatal Outcome of 38 Cases With Congenital Diaphragmatic Hernia: 8-Year Experience of a Tertiary Brazilian Center

Ruano

Bunduki

Silva

et al. 2006

Clinics

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“…ongenital diaphragmatic hernia (CDH) diagnosed in utero has a neonatal mortality rate of 50% to 80%, [1][2][3][4][5][6][7] death being mainly due to pulmonary hypoplasia. Predicting the neonatal outcome prenatally remains a challenge.…”

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confidence: 99%

Evaluation of Fetal Pulmonary Vasculature by Power Doppler Imaging in Congenital Diaphragmatic Hernia

Michelet

Aubry

Sayed

et al. 2004

J of Ultrasound Medicine

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Objective. To evaluate the feasibility of prenatal power Doppler imaging of pulmonary arteries in congenital diaphragmatic hernia and to study its potential to predict outcome. Methods. A prospective observational study was conducted. Forty-two cases of congenital diaphragmatic hernia (32 left and 10 right) without associated anomalies were analyzed. Qualitative evaluation of pulmonary vasculature was based on power Doppler imaging performed at 26 to 38 weeks. The pulmonary arteries were studied in the lung contralateral to the hernia. Pulmonary Doppler angiography was considered satisfactory when 3 levels of bifurcation defining 3 distinct segments of the pulmonary arteries were imaged and was otherwise considered poor. We also recorded the gestational age at diagnosis, side of the hernia, abdominal circumference below the third percentile, amniotic fluid volume, lung/thoracic area ratio, left/right ventricle ratio, and, in left-sided hernias, stomach position, and we carried out a multivariate analysis to determine the contribution of each factor to predict neonatal mortality. Results. More than 3 divisions of the fetal pulmonary arteries were imaged in 20 cases; 1 or 2 divisions or none were imaged in 22. Neonatal mortality was significantly greater when fewer than 3 divisions of the pulmonary arteries were imaged (18 [82%] of 22) than when 3 divisions could be identified on power Doppler imaging (5 [25%] of 20; P = .0005). However, the lung/thoracic area ratio was the only factor that remained significantly associated with mortality in the multivariate analysis. Conclusions. An altered pulmonary power Doppler image is associated with neonatal mortality, but estimation of the lung area remains the best predictor of neonatal outcome. Key words: congenital diaphragmatic hernia; lung/head ratio; lung/thorax ratio; power Doppler imaging; prenatal diagnosis; pulmonary hypoplasia; sonography. ongenital diaphragmatic hernia (CDH) diagnosed in utero has a neonatal mortality rate of 50% to 80%, 1-7 death being mainly due to pulmonary hypoplasia. Predicting the neonatal outcome prenatally remains a challenge. Moreover, prenatal staging of CDH is becoming increasingly important as new intrauterine therapeutic interventions emerge, including minimally invasive fetal surgery.8 So far, research on prenatal prediction of pulmonary hypoplasia has focused on using sonography or magnetic resonance imaging to assess the size of the lungs, 7,9-14 the degree of herniation of abdominal organs, 6,15,16 and the consequences of fetal hemodynamic changes on left ventricular size. 17,18 In CDH, however, pulmonary hypoplasia is associated with alterations of the pulmonary vasculature, accounting for potentially lethal postnatal pulmonary hypertension.19

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“…Hypoplasia and pulmonary hypertension lead to respiratory distress and are primarily responsible for post-natal death 2. Mortality used to be 50% in patients with isolated CDH, and around 80% with associated anomalies [4][5][6][7] , but in some centers it has been dropping to 20-30% with the introduction of standardized treatment protocols 1,3 . Due to hypoplasia and pulmonary hypertension, patients with CDH have a difficult ventilatory handling, with right to left shunt, hypoxia, hypercapnia, and mixed acidosis.…”

Section: Introduction Introduction Introduction Introductionmentioning

confidence: 99%

Standardization of pulmonary ventilation technique using volume-controlled ventilators in rats with congenital diaphragmatic hernia

Gallindo

Gonçalves

Figueira

et al. 2014

Rev. Col. Bras. Cir.

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ABSTRACT ABSTRACT ABSTRACTObjective Objective Objective Objective Objective: To standardize a technique for ventilating rat fetuses with Congenital Diaphragmatic Hernia (CDH) using a volumecontrolled ventilator. Methods Methods Methods Methods Methods: Pregnant rats were divided into the following groups: a) control (C); b) exposed to nitrofen with CDH (CDH); and c) exposed to nitrofen without CDH (N-). Fetuses of the three groups were randomly divided into the subgroups ventilated (V) and non-ventilated (N-V). Fetuses were collected on day 21.5 of gestation, weighed and ventilated for 30 minutes using a volume-controlled ventilator. Then the lungs were collected for histological study. We evaluated: body weight (BW), total lung weight (TLW), left lung weight (LLW), ratios TLW / BW and LLW / BW, morphological histology of the airways and causes of failures of ventilation. Results Results ResultsResults Results: BW, TLW, LLW, TLW / BW and LLW / BW were higher in C compared with N-(p <0.05) and CDH (p <0.05), but no differences were found between the subgroups V and N-V (p> 0.05). The morphology of the pulmonary airways showed hypoplasia in groups N-and CDH, with no difference between V and N-V (p <0.05). The C and N-groups could be successfully ventilated using a tidal volume of 75 ìl, but the failure of ventilation in the CDH group decreased only when ventilated with 50 ìl. Conclusion Conclusion Conclusion Conclusion Conclusion: Volume ventilation is possible in rats with CDH for a short period and does not alter fetal or lung morphology.

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A Prospective Study of the Outcome for Fetuses With Diaphragmatic Hernia

Cited by 300 publications

References 20 publications

Prenatal Diagnosis and Perinatal Outcome of 38 Cases With Congenital Diaphragmatic Hernia: 8-Year Experience of a Tertiary Brazilian Center

Prenatal Diagnosis and Perinatal Outcome of 38 Cases With Congenital Diaphragmatic Hernia: 8-Year Experience of a Tertiary Brazilian Center

Evaluation of Fetal Pulmonary Vasculature by Power Doppler Imaging in Congenital Diaphragmatic Hernia

Standardization of pulmonary ventilation technique using volume-controlled ventilators in rats with congenital diaphragmatic hernia

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