Right Congenital Diaphragmatic Hernias: Is There a Correlation between Prenatal Lung Volume and Postnatal Survival, as in Isolated Left Diaphragmatic Hernias?

Victoria, Teresa; Danzer, Enrico; Oliver, Edward R.; Edgar, J. Christopher; Iyoob, Suzanne D.; Partridge, Emily A.; Johnson, Ann; Peranteau, William H.; Coleman, Beverly G.; Flake, Alan W.; Johnson, Mark P.; Hedrick, Holly H.; Adzick, N. Scott

doi:10.1159/000464246

Cited by 24 publications

(17 citation statements)

References 22 publications

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“…However, the anatomical difference between left and right CDH makes the application of the liver status irrelevant because the liver is almost always up in every case of RCDH. Similar to previous reports, liver herniation was observed in almost all patients with RCDH [ 9 , 14 ]. The degree of liver herniation, manifested by the percentage of the herniated liver and measured by fetal magnetic resonance imaging (MRI), was suggested as a prenatal indicator of LCDH [ 32 ]; however, the volume of the herniated liver was not found to be predictive of survival in a recent study on RCDH [ 14 ].…”

Section: Discussionsupporting

confidence: 90%

“…Similar to previous reports, liver herniation was observed in almost all patients with RCDH [ 9 , 14 ]. The degree of liver herniation, manifested by the percentage of the herniated liver and measured by fetal magnetic resonance imaging (MRI), was suggested as a prenatal indicator of LCDH [ 32 ]; however, the volume of the herniated liver was not found to be predictive of survival in a recent study on RCDH [ 14 ]. We had no data on the herniated liver volume because fetal MRI data were unavailable.…”

Section: Discussionsupporting

confidence: 90%

“…In contrast, Victoria et al . raised questions regarding the reliability of the O/E LHR as a predictor of RCDH [ 14 ]. In this single-center study, the survival rate of RCDH was relatively high (up to 60%) even in patients with an O/E LHR of < 45%, probably because the results were derived from only five cases.…”

Section: Discussionmentioning

confidence: 99%

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Prenatal prognostic factors for isolated right congenital diaphragmatic hernia: a single center’s experience

et al. 2021

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Background Right-sided congenital diaphragmatic hernia (RCDH) is relatively rare compared with left-sided congenital diaphragmatic hernia (LCDH). Clinical data of RCDH, especially with respect to antenatal prediction of neonatal outcome, are lacking. The aim of this study was to report the treatment outcomes of patients with antenatally diagnosed RCDH and to evaluate the predictability of observed-to-expected lung area-to-head circumference ratio (O/E LHR) for perinatal outcomes, focused on mortality or extracorporeal membrane oxygenation (ECMO) requirement. Methods We retrospectively reviewed the medical records of newborn infants with isolated RCDH. We analyzed and compared the clinical and prenatal characteristics including the fetal lung volume, which was measured as the O/E LHR, between the survivors and the non-survivors. Results A total of 26 (66.7%) of 39 patients with isolated RCDH survived to discharge. The O/E LHR was significantly greater in survivors (64.7 ± 21.2) than in non-survivors (40.5 ± 23.4) (P =.027). It was greater in survivors without ECMO requirement (68.3 ± 15.1) than non-survivors or those with ECMO requirement (46.3 ± 19.4; P = .010). The best O/E LHR cut-off value for predicting mortality in isolated RCDH was 50. Conclusions The findings in this study suggest that O/E LHR, a well-characterized prognostic indicator in LCDH, could be applied to a fetus with antenatally diagnosed RCDH. A large cohort study is required to verify the association between O/E LHR values and the graded severity of RCDH.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 90%

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Prenatal prognostic factors for isolated right congenital diaphragmatic hernia: a single center’s experience

et al. 2021

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“…Medical record information did not allow further classification by defect size, which has been noted as an important prognostic factor, particularly for morbidity at discharge (Putnam et al, ). Moreover, although right‐side CDH might have worse outcomes and different prognostic factors from left‐sided defects (Victoria et al, ), we were unable to investigate this variable. For similar reasons, the impact of liver position (intra‐ vs. extrathoracic) on survival, a known prognostic factor (Mullassery et al, ), may have been underestimated.…”

Section: Discussionmentioning

confidence: 99%

Epidemiology and Prognosis of Congenital Diaphragmatic Hernia: A Population‐Based Cohort Study in Utah

Shanmugam

Brunelli

Botto

et al. 2017

Birth Defects Research

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“…(7) DeKoninck et al reported that after expectant in utero management, the survival rates in patients with RCDH and an O/E LHR of < 45% and < 30% were 17% and 0%, respectively. (21) In contrast, Victoria et al raised questions regarding the reliability of the O/E LHR as a predictor of RCDH (20). In this single-center study, the survival rate of RCDH was relatively high (up to 60%) even in patients with an O/E LHR of < 45%, probably because the results were derived from only ve cases.…”

mentioning

confidence: 83%

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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Right Congenital Diaphragmatic Hernias: Is There a Correlation between Prenatal Lung Volume and Postnatal Survival, as in Isolated Left Diaphragmatic Hernias?

Cited by 24 publications

References 22 publications

Prenatal prognostic factors for isolated right congenital diaphragmatic hernia: a single center’s experience

Prenatal prognostic factors for isolated right congenital diaphragmatic hernia: a single center’s experience

Epidemiology and Prognosis of Congenital Diaphragmatic Hernia: A Population‐Based Cohort Study in Utah

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

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