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Fetal liver position and perinatal outcome for congenital diaphragmatic hernia
C T Albanese1, J Lopoo, R B Goldstein
1Department of Surgery, University of California, San Francisco 94143-0570, USA. craig@itsa.ucsf.edu
Insights
Congenital diaphragmatic hernia (CDH) with prenatal liver herniation into the chest significantly worsens outcomes. Prenatal diagnosis of liver position in CDH fetuses is crucial for predicting prognosis and preparing for neonatal care.
Area of Science:
- Pediatric Surgery
- Fetal Medicine
- Neonatal Care
Background:
- Congenital diaphragmatic hernia (CDH) remains a significant cause of neonatal morbidity and mortality despite advances in postnatal care.
- Accurate prenatal diagnosis and prognostic indicators are essential for optimizing management strategies in fetuses with CDH.
Purpose of the Study:
- To evaluate the prognostic impact of prenatally diagnosed liver herniation in the hemithorax in fetuses with left-sided congenital diaphragmatic hernia (CDH).
Main Methods:
- Retrospective review of medical records for 48 patients with prenatally diagnosed left CDH.
- Classification of fetuses into 'liver up' (major portion herniated into hemithorax) and 'liver down' (intra-abdominal liver) groups based on prenatal ultrasound with colour-flow Doppler.
- Analysis of fetal deaths, need for extracorporeal membrane oxygenation (ECMO) support, and postnatal survival rates between the two groups.
Main Results:
- The 'liver up' group (32 fetuses) had a higher incidence of fetal deaths and required significantly more extracorporeal membrane oxygenation (ECMO) support (53%) compared to the 'liver down' group (16 fetuses, 19%).
- Postnatal survival rates were markedly lower in the 'liver up' group (43%) compared to the 'liver down' group (93%).
Conclusions:
- Prenatal diagnosis of liver herniation into the hemithorax in fetuses with CDH indicates a significantly poorer prognosis.
- Prenatal ultrasonographic assessment of liver position in CDH is vital for anticipating neonatal outcomes, enabling timely intervention, and facilitating family counseling.
Abstract:
Despite advances in postnatal care, patients born with a congenital diaphragmatic hernia (CDH) suffer substantial morbidity and mortality. The present study was undertaken to determine the prognostic influence of prenatally-diagnosed liver herniation in the hemithorax in fetuses with CDH. The medical records of 48 patients evaluated for a prenatally-diagnosed left CDH were retrospectively reviewed. Patients were analysed according to the position of the liver by prenatal ultrasound; 32 fetuses had a major portion of the liver herniated into the left hemithorax ('liver up') and 16 had an intra-abdominal liver ('liver down'). Liver position was determined using colour-flow Doppler ultrasonography. There were two fetal deaths in the liver-up group and one in the liver-down group. The liver-up group more frequently required extracorporeal membrane oxygenation (ECMO) support (53 per cent) compared with the liver-down group (19 per cent). Postnatal survival was significantly less in the liver-up group (43 per cent) vs. the liver-down group (93 per cent). Fetuses with congenital diaphragmatic hernia and liver herniated into the hemithorax have a much worse prognosis than similarly afflicted fetuses without liver herniation. Prenatal ultrasonographic diagnosis of congenital diaphragmatic hernia allows for preparation for a critically ill newborn and aids in prenatal family counselling.