No abstract

Objective: To evaluate natural history of fetuses congenital diaphragmatic hernia (CDH) prenatally diagnosed in countries where termination of pregnancy is not legally allowed and to predict neonatal survival according to lung area and liver herniation. Methods:Prospective study including antenatally diagnosed CDH cases managed expectantly during pregnancy in six tertiary Latin American centres. The contribution of the observed/expected lung-to-head ratio (O/E-LHR) and liver herniation in predicting neonatal survival was assessed.Results: From the total population of 380 CDH cases, 144 isolated fetuses were selected showing an overall survival rate of 31.9% (46/144). Survivors showed significantly higher O/E-LHR (56.5% vs 34.9%; P < .001), lower proportion of liver herniation (34.8% vs 80.6%, P < .001), and higher gestational age at birth (37.8 vs 36.2 weeks, P < 0.01) than nonsurvivors. Fetuses with an O/E-LHR less than 35%

This study on fetuses with isolated left-sided congenital diaphragmatic hernia (CDH) and severe pulmonary hypoplasia provides evidence that fetal endoscopic tracheal occlusion may be of benefit in improving neonatal survival in settings with neonatal intensive care limitations, such as unavailability and/or inexperience in the use of extracorporeal membrane oxygenation therapy, and thus a high neonatal mortality rate. What are the clinical implications of this work? The outcomes reported in this study may be of interest to centers in which termination of pregnancy is illegal and neonatal management is considered suboptimal, as they demonstrate that fetal intervention in experienced fetal surgery centers represents an improvement in neonatal survival for fetuses with isolated severe left-sided CDH.

No abstract