Prenatal prognosis in isolated congenital diaphragmatic hernia

Area of Science:

• Neonatology
• Pediatric Surgery
• Medical Imaging

Background:

• Isolated diaphragmatic hernia (IDH) is a severe congenital anomaly.
• Accurate prediction of neonatal outcome is crucial for management.
• Prenatal diagnosis allows for early assessment.

Purpose of the Study:

• To identify prenatal parameters predicting severity in isolated diaphragmatic hernia.
• To correlate antenatal findings with postnatal survival.

Main Methods:

• Retrospective monocentric study of 79 neonates with antenatally diagnosed IDH.
• Analysis of prenatal parameters including age at diagnosis, polyhydramnios, cardiac indices, liver position, and lung measurements (fetal lung area to head circumference ratio, fetal lung volume ratio via MRI).
• Evaluation of postnatal survival rates and treatment protocols (early high-frequency ventilation, inhaled nitric oxide, delayed surgery).

Main Results:

• Overall postnatal survival rate was 63.3%.
• No significant correlation found between survival and age at diagnosis, polyhydramnios, or left ventricle/right ventricle index.
• Neonatal mortality was significantly associated with the side of the diaphragmatic defect, intrathoracic liver position, and fetal lung volume measurements.
• All 9 neonates with left IDH and intra-abdominal stomach survived.

Conclusions:

• No single prenatal factor reliably predicts neonatal outcome in isolated diaphragmatic hernia.
• Prenatal imaging, particularly fetal lung volume assessment, is valuable for stratifying disease severity.
• Accurate stratification aids in comparing different postnatal therapeutic strategies.