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. 2021 Oct 20;21(1):460.
doi: 10.1186/s12887-021-02931-6.

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

Jiyoon Jeong  1 , Byong Sop Lee  2 , Teahyen Cha  1 , Euiseok Jung  1 , Ellen Ai-Rhan Kim  1 , Ki-Soo Kim  1 , Dae Yeon Kim  3 , Jung-Man Namgoong  3 , Seong Chul Kim  3 , Mi-Young Lee  4 , Hye-Sung Won  5
Affiliations

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

Jiyoon Jeong et al. BMC Pediatr. .

Abstract

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.

Keywords: Congenital diaphragmatic hernia; Extracorporeal membrane oxygenation; Observed-to-expected lung area-to-head circumference ratio; Right-sided congenital diaphragmatic hernia.

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Conflict of interest statement

The authors have no conflicting financial interests.

Figures

Fig. 1
Fig. 1
The O/E LHR and clinical outcomes depending on mortality and ECMO requirement: survivors without ECMO (Group A, open circles), survivors with ECMO (Group B, open rectangles), non-survivors without ECMO (Group C, closed circles), and non-survivors with ECMO (group D, closed rectangles). The O/E LHR was compared among the 4 subgroups (A), survivors (A, B) versus non-survivors (C, D) (B), and survivors without ECMO (A) versus non-survivors or ECMO (B, C, D) (C). Long midline bars indicate the median value in each group, respectively. * P < .005, ** P < .05. O/E LHR, observed-to-expected lung area-to-head circumference ratio; ECMO, extracorporeal membrane oxygenation
Fig. 2
Fig. 2
The ROC curve for predicting perinatal outcomes according to the O/E LHR. The ROC curve for predicting mortality (A) and mortality or ECMO requirement (B) in RCDH according to O/E LHR. AUC values were 0.768 (95% CI, 0.527–1.000; P = 0.045) and 0.815 (95% CI, 0.616–1.000; P = .011), respectively. ROC, receiver operating characteristic; O/E LHR, observed-to-expected lung area-to-head circumference ratio; AUC, area under the curve; ECMO, extracorporeal membrane oxygenation; CI, confidence interval
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References

    1. Tsao K, Lally KP. The congenital diaphragmatic hernia study group: a voluntary international registry. Semin Pediatr Surg. 2008;17:90–97. doi: 10.1053/j.sempedsurg.2008.02.004. - DOI - PubMed
    1. Yu PT, Jen HC, Rice-Townsend S, Guner YS. The role of ECMO in the management of congenital diaphragmatic hernia. Semin Perinatol. 2020;44:151–66. - PubMed
    1. Snoek KG, Greenough A, van Rosmalen J, Capolupo I, Schaible T, Ali K, et al. Congenital diaphragmatic hernia: 10-year evaluation of survival, extracorporeal membrane oxygenation, and foetoscopic endotracheal occlusion in four high-volume centres. Neonatology. 2018;113:63–8. doi: 10.1159/000480451. - DOI - PubMed
    1. Oluyomi-Obi T, Kuret V, Puligandla P, Lodha A, Lee-Robertson H, Lee K, et al. Antenatal predictors of outcome in prenatally diagnosed congenital diaphragmatic hernia (CDH) J Pediatr Surg. 2017;52:881–8. doi: 10.1016/j.jpedsurg.2016.12.008. - DOI - PubMed
    1. Alfaraj MA, Shah PS, Bohn D, Pantazi S, O'Brien K, Chiu PP, et al. Congenital diaphragmatic hernia: lung-to-head ratio and lung volume for prediction of outcome. Am J Obstet Gynecol. 2011;205(43):e41–8. - PubMed

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