Comparative outcomes of right versus left congenital diaphragmatic hernia: A multicenter analysis

Abramov, Alexey; Fan, Weijia; Hernan, Rebecca; Zenilman, Ariela; Wynn, Julia; Aspelund, Guðrún; Khlevner, Julie; Krishnan, Usha; Lim, Foong Yen; Mychaliska, George B.; Warner, Brad W.; Cusick, Robert A.; Crombleholme, Timothy M.; Chung, Dai H.; Danko, Melissa E.; Wagner, Amy J.; Azarow, Kenneth S.; Schindel, David T.; Potoka, Douglas A.; Soffer, Sam; Fisher, Jason C.; McCulley, David J.; Farkouh-Karoleski, Christiana; Chung, Wendy K.; Duron, Vincent

doi:10.1016/j.jpedsurg.2019.09.046

Cited by 26 publications

(18 citation statements)

References 39 publications

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“…Development using standardized tests was performed in 23 studies. 7,16,21,46,48,58,60,67,68,71,[74][75][76]79,85,86,88,89,91,92,95,110,114,115 When pooled together, 18% (11%-26%) of children scored abnormally on these tests. There was a large difference between the different tests used.…”

Section: Developmentmentioning

confidence: 99%

Neurodevelopmental outcomes in children with isolated congenital diaphragmatic hernia: A systematic review and meta‐analysis

et al. 2021

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Background: Congenital diaphragmatic hernia (CDH) reportedly has neurologic consequences in childhood however little is known about the impact in isolated CDH.Aims: Herein we aimed to describe the risk of neurodevelopmental complications in children born with isolated CDH. Materials & Methods:We systematically reviewed literature for reports on the neurological outcome of infants born with isolated CDH. The primary outcome was neurodevelopmental delay. Secondary outcomes included, motor skills, intelligence, vision, hearing, language and behavior abnormalities.Results: Thirteen out of 87 (15%) studies reported on isolated CDH, including 2624 out of 24,146 children. Neurodevelopmental delay was investigated in four studies and found to be present in 16% (3-34%) of children. This was mainly attributed to motor problems in 13% (2-30%), whereas cognitive dysfunction only in 5% (0-20%) and hearing in 3% (1-7%). One study assessed the effect of fetal surgery. When both isolated and non-isolated children were included, these numbers were higher. Discussion: This systematic review demonstrates that only a minority of studies focused on isolated CDH, with neurodevelopmental delay present in 16% of children born with CDH. Conclusion:To accurately counsel patients, more research should focus on isolated CDH cases and examine children that underwent fetal surgery. Lennart Van der Veeken and Simen Vergote shared first authorship. #Jan Deprest and Matteo Bruschettini shared last authorship.This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

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Section: Developmentmentioning

confidence: 99%

Neurodevelopmental outcomes in children with isolated congenital diaphragmatic hernia: A systematic review and meta‐analysis

et al. 2021

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“…Right-sided CDH (RCDH) is far less common than left-sided, accounting for only 15-20% of cases, and, therefore, solid data concerning this condition are rare. Available evidence is controversial on whether RCDH is a more severe condition than is LCDH and/or a separate entity with different outcomes [8][9][10][11] . In a previous study on 67 fetuses with isolated RCDH (iRCDH), we documented an overall survival rate of 53%, which is lower than that for LCDH 12 .…”

Section: Introductionmentioning

confidence: 99%

Fetal endoscopic tracheal occlusion reverses the natural history of right‐sided congenital diaphragmatic hernia: European multicenter experience

Russo

Cordier

Basurto

et al. 2021

Ultrasound in Obstet & Gyne

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Objective To evaluate the neonatal outcome of fetuses with isolated right‐sided congenital diaphragmatic hernia (iRCDH) based on prenatal severity indicators and antenatal management. Methods This was a retrospective review of prospectively collected data on consecutive cases diagnosed with iRCDH before 30 weeks' gestation in four fetal therapy centers, between January 2008 and December 2018. Data on prenatal severity assessment, antenatal management and perinatal outcome were retrieved. Univariate and multivariate logistic regression analysis were used to identify predictors of survival at discharge and early neonatal morbidity. Results Of 265 patients assessed during the study period, we excluded 40 (15%) who underwent termination of pregnancy, two cases of unexplained fetal death, two that were lost to follow‐up, one for which antenatal assessment of lung hypoplasia was not available and six cases which were found to have major associated anomalies or syndromes after birth. Of the 214 fetuses with iRCDH included in the neonatal outcome analysis, 86 were managed expectantly during pregnancy and 128 underwent fetal endoscopic tracheal occlusion (FETO) with a balloon. In the expectant‐management group, lung size measured by ultrasound or by magnetic resonance imaging was the only independent predictor of survival (observed‐to‐expected lung‐to‐head ratio (o/e‐LHR) odds ratio (OR), 1.06 (95% CI, 1.02–1.11); P = 0.003). Until now, stratification for severe lung hypoplasia has been based on an o/e‐LHR cut‐off of 45%. In cases managed expectantly, the survival rate was 15% (4/27) in those with o/e‐LHR ≤ 45% and 61% (36/59) for o/e‐LHR > 45% (P = 0.001). However, the best o/e‐LHR cut‐off for the prediction of survival at discharge was 50%, with a sensitivity of 78% and specificity of 72%. In the expectantly managed group, survivors with severe pulmonary hypoplasia stayed longer in the neonatal intensive care unit than did those with mildly hypoplastic lungs. In fetuses with an o/e‐LHR ≤ 45% treated with FETO, survival rate was higher than in those with similar lung size managed expectantly (49/120 (41%) vs 4/27 (15%); P = 0.014), despite higher prematurity rates (gestational age at birth: 34.4 ± 2.7 weeks vs 36.8 ± 3.0 weeks; P < 0.0001). In fetuses treated with FETO, gestational age at birth was the only predictor of survival (OR, 1.25 (95% CI, 1.04–1.50); P = 0.02). Conclusions Antenatal measurement of lung size can predict survival in iRCDH. In fetuses with severe lung hypoplasia, FETO was associated with a significant increase in survival without an associated increase in neonatal morbidity. © 2020 International Society of Ultrasound in Obstetrics and Gynecology

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“…(26) Controversy continues on whether the laterality of CDH affects mortality. (21)(22)(23)(24)(25)(27)(28)(29) The uncertainty regarding the effect of laterality might be because of the small sample size, relative di culty in prenatal diagnosis of RCDH, and postnatal management policies such as the timing of surgical repair. However, two recent large-scale studies in the United States found no difference in the overall mortality rates of RCDH and LCDH.…”

Section: Discussionmentioning

confidence: 99%

Prenatal Prognostic Factors for Isolated Right Congenital Diaphragmatic Hernia: A Single Center’s Experience

Jeong

Lee

Cha

et al. 2021

Preprint

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Background: Right-sided congenital diaphragmatic hernia (RCDH) is relatively rare. Clinical data of RCDH, especially with respect to antenatal prediction of neonatal outcome, are lacking. This study aimed to report the treatment outcome of newborn infants with RCDH and to identify prenatal prognostic indicators. Methods: We retrospectively reviewed the medical records of newborn infants with isolated RCDH who were born at a gestational age of ≥35 weeks. We analyzed and compared the clinical and prenatal characteristics including the fetal lung volume, which was measured as the observed-to-expected lung area-to-head circumference ratio (O/E LHR), between the survivors and non-survivors. Results: A total of 24 (70.6%) of 34 patients with isolated RCDH survived to discharge. The O/E LHR was significantly greater in survivors (67.0 ± 19.9) than in non-survivors (42.4 ± 25.0) (P < .05). In multivariate analysis, the O/E LHR was found to be a good predictor of mortality or requirement for extracorporeal membrane oxygenation (ECMO) support (area under the curve [AUC], 0.870; P < .01) and mortality (AUC, 0.789; P < .05). The best O/E LHR cut-off value for predicting mortality and mortality or requirement for ECMO support in isolated RCDH was 47. Conclusions: The survival rate of patients with isolated RCDH was comparable to that of patients with left-sided CDH. The O/E LHR of the contralateral lung was a reliable predictor of short-term postnatal outcome in RCDH.

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Comparative outcomes of right versus left congenital diaphragmatic hernia: A multicenter analysis

Cited by 26 publications

References 39 publications

Neurodevelopmental outcomes in children with isolated congenital diaphragmatic hernia: A systematic review and meta‐analysis

Neurodevelopmental outcomes in children with isolated congenital diaphragmatic hernia: A systematic review and meta‐analysis

Fetal endoscopic tracheal occlusion reverses the natural history of right‐sided congenital diaphragmatic hernia: European multicenter experience

Prenatal Prognostic Factors for Isolated Right Congenital Diaphragmatic Hernia: A Single Center’s Experience

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