Prenatal prediction of survival in isolated left‐sided diaphragmatic hernia

Jani, Jacques; Keller, Rodolfo; Benachi, Alexandra; Nicolaides, Kypros H.; Favre, R.; Gratacós, Eduard; Laudy, J. A. M.; Eisenberg, V. H.; Eggink, Alex J.; Vaast, P.; Deprest, Jan

doi:10.1002/uog.2688

Cited by 272 publications

(229 citation statements)

References 21 publications

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“…The surrounding fluid could have increased the measured SI of the lung in such cases, which would account for the lack of significant change in the lung/liver SI ratio between the two groups. Liver herniation into the hemithorax and LHR are reported to be poor prognostic factors in CDH (12,26,27). When liver down was considered as an indicator of postnatal survival, sensitivity (3/9, 33.3%) and NPV (5/11, 45.5%) were relatively low in our study, although high specificity and PPV of 100% (5/5 and 3/3) were obtained.…”

Section: Discussioncontrasting

confidence: 61%

MR prediction of postnatal outcomes in left‐sided congenital diaphragmatic hernia using right lung signal intensity: Comparison with that using right lung volume

Nishie

Tajima

Asayama

et al. 2009

Magnetic Resonance Imaging

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Purpose: 1 To investigate the validity of the fetal right lungto-liver signal intensity ratio (LLSIR) for prediction of postnatal outcomes in left-sided congenital diaphragmatic hernia (CDH). Materials and Methods:The study included 14 pregnant women who underwent MR exams for evaluation of fetal left-sided CDH. The fetuses were divided into two groups: Group A (n ϭ 9), alive, and Group B (n ϭ 5), dead. On the basis of the half-Fourier acquisition single-shot turbo spinecho sequence, LLSIR and the right fetal lung volume (FLV) was calculated. In the control group, a regression analysis was performed to associate LLSIR and right FLV with gestational age. The relative LLSIR and right FLV (the observed/expected LLSIR and right FLV) were compared between Groups A and B. Results:The mean relative LLSIR, as well as the mean relative right FLV, of Group A was significantly higher than that of Group B (p ϭ 0.035). Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for the relative LLSIR and the relative right FLV, when the cutoff point was defined as 0.646 and 0.420, were the same and were 88.9%, 80.0%, 88.9%, 80.0%, and 85.7%, respectively. Conclusion:The postnatal outcomes in left-sided CDH may be predicted using the LLSIR.

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Section: Discussioncontrasting

confidence: 61%

MR prediction of postnatal outcomes in left‐sided congenital diaphragmatic hernia using right lung signal intensity: Comparison with that using right lung volume

Nishie

Tajima

Asayama

et al. 2009

Magnetic Resonance Imaging

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“…13 Fetuses with liver 'up' have a 50% chance of survival overall. When such a fetus has an LHR in the range 1.0-1.6, it may survive in 66% of cases; with an LHR above 1.6, this figure increases to 83%.…”

Section: Discussionmentioning

confidence: 99%

Prenatal diagnosis of ectopic intrathoracic kidney in a fetus with a left diaphragmatic hernia

Panda

Rosenberg

Cornfeld

et al. 2008

J of Clinical Ultrasound

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Intrathoracic renal ectopia as a result of a congenital diaphragmatic hernia (CDH) is a rare congenital anomaly. We present a case in which the prenatal diagnosis of an ectopic intrathoracic kidney was made on routine anatomical survey at 28 weeks' gestation. Color doppler sonography imaging revealed the renal artery coursing into the infant's thorax and was consistent with CDH, but fetal MRI suggested an intact diaphragm. However, neonatal evaluation confirmed the diagnosis of intrathoracic kidney with posterior CDH, which was repaired without complication. In contrast to diaphragmatic hernia with liver or bowel herniation, infants with intrathoracic ectopic kidneys generally do well.

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“…Liver herniation is an independent predictor of mortality in CDH 15 22 , 26 , 28 , 29 A left‐sided CDH with liver up, is indicative of an early, large defect 22 . Overall mortality is poorer with up to 55% mortality with liver‐up, compared to 6–26% mortality with liver‐down 15 …”

Section: Pathogenesismentioning

confidence: 99%

“…Numbers in RCTs are small. Complications are significant and can include up to a 47% chance of premature rupture of membranes 26 and pre‐term delivery. In addition, the balloon has to be removed before planned delivery or will need to be removed as an emergency procedure at birth.…”

Section: Future Therapymentioning

confidence: 99%

A review of congenital diaphragmatic hernia

Marlow

Thomas

2013

Australas J Ultrason Med

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Background: Congenital diaphragmatic hernia (CDH) is a simple diaphragmatic defect that is seen frequently in antenatal scans. Though the surgical repair is relatively easy in the neonate, the mortality is high due to pulmonary hypoplasia and pulmonary vascular changes. Materials and Methods: The goals of prenatal imaging are to establish the diagnosis. Assessment in a tertiary scanning center would identify prognostic factors which assist in counselling and planning antenatal management. However, the pulmonary hypoplasia associated with the CDH in moderate and severe cases makes the prognosis poor. Conclusions: Fetal intervention such as, fetal tracheal occlusion, is being trialled and may change the outcomes in the future.

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Prenatal prediction of survival in isolated left‐sided diaphragmatic hernia

Abstract: K E Y W O R D S:

Cited by 272 publications

References 21 publications

MR prediction of postnatal outcomes in left‐sided congenital diaphragmatic hernia using right lung signal intensity: Comparison with that using right lung volume

MR prediction of postnatal outcomes in left‐sided congenital diaphragmatic hernia using right lung signal intensity: Comparison with that using right lung volume

Prenatal diagnosis of ectopic intrathoracic kidney in a fetus with a left diaphragmatic hernia

A review of congenital diaphragmatic hernia

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