Do Serial Sonographic Assessments of Fetuses with Isolated Congenital Diaphragmatic Hernia Help Us Predict Survival?

Abstract

<b><i>Objective:</i></b> The aim of this study was to assess the ability of serial prenatal sonographic measurements, and specifically changes in the observed-to-expected lung-to-head ratio (O/E LHR) throughout gestation and to predict survival in congenital diaphragmatic hernia (CDH). <b><i>Methods:</i></b> Retrospective study of CDH fetuses evaluated prenatally and treated postnatally in a single tertiary center, 2008–2020. Sonographic evaluations included side of herniation, liver involvement, and O/E LHR. All data were calculated to assess ability to predict survival. <b><i>Results:</i></b> Overall, 94 fetuses were evaluated prenatally and delivered in our medical center. Among them, 75 had isolated CDH and 19 nonisolated. CDH was categorized as left (<i>n</i> = 76; 80.8%), right (<i>n</i> = 16; 17.0%), or bilateral (<i>n</i> = 2; 2.2%). Overall perinatal survival rate was 57% for all live-born infants, 68% in isolated CDH, and 40% in nonisolated (excluding 2 cases that underwent fetoscopic endoluminal tracheal occlusion and did not survive). The O/E LHR was lower in cases with perinatal death compared to survivors. In cases with multiple evaluations, the minimal O/E LHR was the most accurate predictor of survival and need for perinatal extracorporeal membrane oxygenation (ECMO) support. This remained significant when excluding twin pregnancies or when evaluating only isolated left CDH. In addition to disease severity, the side of herniation and liver position was associated with preoperative mortality. <b><i>Conclusion:</i></b> O/E LHR is associated with perinatal survival. In cases with multiple evaluations, the minimal O/E LHR is the most accurate and significant predictor of perinatal mortality and need for ECMO support.

Early echocardiographic pulmonary artery measurements as prognostic indicators in left congenital diaphragmatic hernia

“…It is measured during the prenatal period, which means there is a time interval between measurement and postnatal management. In addition, although the o/e LHR does not change with advancing gestational age [ 6 , 13 ], in cases of multiple evaluation, the minimal value is known to be the most accurate and significant predictor of outcomes [ 14 ], so single measurement of the o/e LHR might be less accurate. Furthermore, 30–40% of patients with CDH were not diagnosed prenatally; therefore, their o/e LHR was not available [ 15 , 16 ].…”