Decreased neonatal morbidity in ‘stomach‐down’ left congenital diaphragmatic hernia: implications of prenatal ultrasound diagnosis for counseling and postnatal management

Abstract

What are the novel findings of this work?This study presents the prenatal ultrasound findings and postnatal outcome of patients with left congenital diaphragmatic hernia (CDH) without liver herniation according to stomach position, demonstrating, for the first time, decreased morbidity in those without ('stomach-down' CDH) compared to those with ('stomach-up' CDH) intrathoracic stomach herniation. This is the first study to suggest stomach-down CDH as a separate entity. What are the clinical implications of this work?Our findings highlight the importance of identifying stomach-down CDH prenatally and distinguishing this entity from a congenital lung lesion and from stomach-up CDH, as contralateral lung size is insufficient for predicting postnatal outcome. This knowledge can better inform prenatal family counseling and help anticipate postnatal management.

Reply

“…We appreciate greatly the correspondence of Aiello et al . concerning our study 1 . We agree that abnormal orientation of the stomach resulting in it being in contact with the urinary bladder can be seen in ‘stomach‐down’ left congenital diaphragmatic hernia (CDH).…”

ECMO utilization in infants with congenital diaphragmatic hernia in the USA

“…Advancements in fetal diagnosis and assessment of lung volumes by ultrasound and fetal MRI in CDH infants allows for improved prepartum and peripartum planning, such as an arrangement of delivery at a tertiary or quaternary center, and for better preparation of healthcare teams and resource mobilization. [25][26][27][28] In our study, utilization of ECMO in CDH infants was significantly different between racial groups, inborn versus outborn status, hospital type and hospital region. The highest proportion of ECMO use was noted in infants categorized as Black or 'other' race, those infants who were inborn, those treated in urban teaching hospitals and in the Northeast.…”

“…Advancements in fetal diagnosis and assessment of lung volumes by ultrasound and fetal MRI in CDH infants allows for improved prepartum and peripartum planning, such as an arrangement of delivery at a tertiary or quaternary center, and for better preparation of healthcare teams and resource mobilization. 25–28 …”

Congenital diaphragmatic hernia: a single-centre experience at Kepler University Hospital Linz

“…Equally, it seems more important than lung size itself, in that there were fewer patients with pulmonary hypertension in the "stomach down" group. A retrospective analysis comparing "stomach down" and "stomach and bowel" CDH patients is dealing with this subject [24].…”