Abstract 196

Aim: The impact of prenatal diagnosis on survival in live births with isolated congenital diaphragmatic hernia (CDH) was studied in 8 population-based registries of congenital malformations (Eurocat).

Methods: Cases were identified in existing registries of congenital malformations. Additional information about treatment and outcome were taken from medical records. Only cases diagnosed before birth or during first week of life were included.

Results: 183 cases were identified. Forty percent survived until first discharge from hospital. CDH was diagnosed prenatal in 39% of the cases. Only 4/26 (15%) cases diagnosed before 24 weeks of gestation survived while 15/34 (44%) diagnosed after 24 weeks of gestation survived. Among live births diagnosed after birth 47% survived. Apgar score was a very sensitive indicator of survival. There was significantly regional difference in the use of intensive care (NO, ECMO) (p < 0,05) without regional difference in survival. There was no increase in survival over time (1985-95). For survivors most frequent health problems were recurrent or chronic lung symptoms and gastro-esophageal reflux. Among infants diagnosed after birth 66% were having a normal quality of life whereas 32% of those diagnosed prenatal were doing well without symptoms (p< 0,05)

Conclusions: When diagnosis was performed prenatal early diagnosis of CDH was a significant indicator for severity. There was no increase in survival over 10 years. Severe lung hypoplasia at the time of birth often makes survival impossible. Future treatment regimens that will improve fetal lung growth may be the only promising way to increase survival in live births with CDH.