Abstract
Objective: In utero diagnosed congenital diaphragmatic hernia (CDH) is associated to high antenatal and neonatal loss rates. Accurate prediction of outcome is crucial in counselling parents about management options. We evaluated Lung-to-Head Ratio (LHR) and liver position in prediction of outcome of isolated Left CDH.
Methods: Retrospective review of consecutive patients diagnosed with isolated LCDH prior to 28 weeks, evaluated at 6 tertiairy units from 1995 onwards. Only patients with LHR measurements, obtained by experienced sonographers and with determined liver position by ultrasound or MRI, both <or=28 wks, were included. Outcome measure was survival at discharge from NICU.
Results: 134 cases were available for review; LHR was obtained at a mean of 24.4+/- 2.8 wks. Eleven patients (8%) opted for termination after being evaluated, all having LHR<1.4. There were no postnatal diagnoses of chromosomal anomalies. Overall survival rate was 43% (58/134), after substraction of antenatal losses it was 47% (58/123). LHR correlated to survival irrespective of liver position. In case of liver herniation survival was 35 %. Combination of both variables predicted neonatal outcome better: liver up & LHR<1 predicted a survival of 9%. When LHR<0.8 & liver up, there were no survivors, but with liver down (37% of cases) survival was 40%. When LHR<0.6 there were no survivors irrespective of liver position.
Conclusion: Combination of liver up & LHR <1 at <or=28 wks predicts a <10 % chance of survival, dropping to 0% if LHR<0.8. 8% of patients opted for termination after second opinion, all with LHR<1.4, but only in half this coincided with the above poor prognostic indicators.
Article PDF
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Jani, J., Benachi, A., Keller, R. et al. 183 Lung-To-Head Ratio and Liver Position to Predict Outcome in Early Diagnosed Isolated Left Sided Diaphragmatic Hernia Fetuses: A Multicenter Study.. Pediatr Res 58, 386 (2005). https://doi.org/10.1203/00006450-200508000-00212
Issue Date:
DOI: https://doi.org/10.1203/00006450-200508000-00212