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Outcomes of congenital diaphragmatic hernia: a 12-year experience
Rebekah A Samangaya1, Safiyya Choudhri, Fiona Murphy
1Fetal Medicine Unit, St Mary's Hospital, Oxford Road, Manchester, M13 9WL, UK. Rebekah.samangaya@cmft.nhs.uk
Insights
Congenital diaphragmatic hernia (CDH) outcomes were analyzed. Prenatal diagnosis of CDH significantly impacts survival rates, with lower birth weight also being a critical factor.
Area of Science:
- Neonatal surgery
- Pediatric surgery
- Fetal medicine
Background:
- Congenital diaphragmatic hernia (CDH) is a serious birth defect.
- Accurate outcome prediction is crucial for prenatal counseling.
Purpose of the Study:
- To determine outcomes for babies with congenital diaphragmatic hernia (CDH).
- To compare outcomes between prenatally and postnatally diagnosed CDH cases.
Main Methods:
- Retrospective review of a fetal medicine database and neonatal surgical unit admission records.
- Inclusion of 171 cases of CDH diagnosed between January 1998 and December 2009.
Main Results:
- 132 cases were prenatally diagnosed, and 39 postnatally.
- Survival to discharge for all live-born babies was 72.6%; survival post-surgery was 91.8%.
- Prenatally diagnosed CDH had significantly lower survival (65.9%) compared to postnatally diagnosed (92.3%).
Conclusions:
- Abnormal karyotypes were more frequent when CDH was associated with other anomalies.
- Lower birth weight and prenatal diagnosis significantly impacted survival.
- Prenatal diagnosis survival data should be used for counseling.
Objective:
To determine outcomes for babies with congenital diaphragmatic hernia (CDH) diagnosed prenatally and postnatally presenting to a tertiary unit.
Method:
Fetal medicine database and neonatal surgical unit admission books were reviewed to identify cases of CDH over a 12-year period (Jan 1998- Dec 2009).
Results:
A total of 132 cases of CDH were diagnosed prenatally and 39 cases diagnosed postnatally. Mean gestation at diagnosis was 22 weeks (range 13-37 weeks). Karyotyping was abnormal in 15.9%; abnormal karyotype in 3.6% of fetuses without other structural anomalies compared with 38.9% when other anomalies were identified. In 45 cases (34.1%) pregnancy was terminated. Two stillbirths occurred (2.3% of ongoing pregnancies). One hundred twenty-four babies were live born, of whom 98 babies underwent surgery. Survival to discharge of all live born babies was 72.6%; survival following surgery was 91.8%. Birthweight had a significant effect on survival (odds ratio 0.22, 95% confidence intervals 0.08-0.66). Survival for live born babies prenatally diagnosed was significantly lower (65.9%) than those diagnosed postnatally (92.3%).
Conclusion:
Abnormal karyotype was more common when CDH was associated with other anomalies. In multivariate analysis, lower birthweight and prenatal diagnosis had a significant impact on survival. Only prenatally diagnosed CDH survival figures should be utilised in prenatal counselling.
