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Comparison of current to past outcomes in congenital diaphragmatic hernia using mri observed-to-expected total fetal lung volume



Fetal Centers use imaging studies to predict congenital diaphragmatic hernia (CDH) prognosis and the need for fetal therapy. Given improving CDH survival, we hypothesized that current fetal imaging severity predictions no longer reflect true outcomes and fail to justify the risks of fetal therapy.


We analyzed our single-center contemporary data in a left-sided CDH cohort (n = 58) by prognostic criteria determined by MRI observed-to-expected total fetal lung volumes: severe <25%, moderate 25–35%, and mild >35%. We compared contemporary survival to prior studies and the TOTAL trials.


Contemporary survival was significantly higher than past studies for all prognostic classifications (mild 100% vs 80–94%, moderate 95% vs 59–75%, severe 79% vs 13–25%; P < 0.01), and to either control or fetal therapy arms of the TOTAL trials.


Current fetal imaging criteria are overly pessimistic and may lead to unwarranted fetal intervention. Fetal therapies remain experimental. Future studies will require updated prognostic criteria.

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Fig. 1: More contemporary cohorts of CDH patients demonstrate improved survival over time.
Fig. 2: The presence of liver in the chest versus the abdomen is an additional risk factor for survival in CDH.
Fig. 3: Survival in the contemporary cohort is greater in the moderate and severe prognostic categories as compared to the expectant management and FETO arms of the TOTAL trial.

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Data availability

The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.


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Authors and Affiliations



Drs. Yang, Ellsworth, and Yoder contributed to the conception and design of the study, data collection and analysis, and manuscript preparation; Drs. Woodward, Kennedy, Fenton, Russell, Byrne, and Yost contributed to conception and design as well as manuscript preparation. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

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Correspondence to Michelle J. Yang.

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Yang, M.J., Ellsworth, T.S., Woodward, P.J. et al. Comparison of current to past outcomes in congenital diaphragmatic hernia using mri observed-to-expected total fetal lung volume. J Perinatol (2024).

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