<b><i>Objective:</i></b> The aim of this study was to assess the ability of serial prenatal sonographic measurements, and specifically changes in the observed-to-expected lung-to-head ratio (O/E LHR) throughout gestation and to predict survival in congenital diaphragmatic hernia (CDH). <b><i>Methods:</i></b> Retrospective study of CDH fetuses evaluated prenatally and treated postnatally in a single tertiary center, 2008–2020. Sonographic evaluations included side of herniation, liver involvement, and O/E LHR. All data were calculated to assess ability to predict survival. <b><i>Results:</i></b> Overall, 94 fetuses were evaluated prenatally and delivered in our medical center. Among them, 75 had isolated CDH and 19 nonisolated. CDH was categorized as left (<i>n</i> = 76; 80.8%), right (<i>n</i> = 16; 17.0%), or bilateral (<i>n</i> = 2; 2.2%). Overall perinatal survival rate was 57% for all live-born infants, 68% in isolated CDH, and 40% in nonisolated (excluding 2 cases that underwent fetoscopic endoluminal tracheal occlusion and did not survive). The O/E LHR was lower in cases with perinatal death compared to survivors. In cases with multiple evaluations, the minimal O/E LHR was the most accurate predictor of survival and need for perinatal extracorporeal membrane oxygenation (ECMO) support. This remained significant when excluding twin pregnancies or when evaluating only isolated left CDH. In addition to disease severity, the side of herniation and liver position was associated with preoperative mortality. <b><i>Conclusion:</i></b> O/E LHR is associated with perinatal survival. In cases with multiple evaluations, the minimal O/E LHR is the most accurate and significant predictor of perinatal mortality and need for ECMO support.

Background: Increasing rates of very advanced maternal age (VAMA, 45 years of age and older) are reported worldwide. Data are available on maternal pregnancy-related morbidity, but they are lacking on the infants’ overall post-partum well-being, including congenital malformations, neonatal complications, and breastfeeding status. Methods: We conducted a retrospective review during the period of 7 years (January 2013 to December 2019). Clinical data recorded in the medical files of 626 VAMA mothers and their singleton newborns in comparison to matched controls comprised advanced maternal age (AMA) mothers and mothers between 20 and 35 years of age. Univariate and multivariate analysis of the data was performed. Results: The infants were significantly less exclusively breastfed during hospitalization (17.4% vs 33.9% and 32.1%, respectively, P <.001). The rate of early transient hypoglycemia was also significantly higher among the newborns of VAMA mothers compared to the AMA and younger-aged mothers (14.7% vs 11.8% and 7%, respectively, P <.001), as was special care unit hospitalization (18.7% vs 15.5% and 13.3%, respectively, P =.03). There was no difference in any other analyzed parameters. Conclusions: Newborns of VAMA mothers are less likely to be exclusively breastfed during hospitalization. They do not exhibit significantly increased major neonatal morbidities, but are more likely to sustain hypoglycemia and neonatal caregivers should be alert to the possibility of newborn early transient hypoglycemia. In an era of growing evidence of the beneficial impact of breast milk on development and immunization, VAMA mothers should be guided and encouraged to breastfed their newborns.