A multicentre study to predict neonatal survival according to lung‐to‐head ratio and liver herniation in fetuses with left congenital diaphragmatic hernia (CDH): Hidden mortality from the Latin American CDH Study Group Registry

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%

Prediction of neonatal survival according to lung‐to‐head ratio in fetuses with right congenital diaphragmatic hernia (CDH): A multicentre study from the Latin American CDH Study Group registry

“…Our findings add to the body of evidence supporting the use of the left lung size by means of the O/E-LHR to stratify the neonatal survival probability in expectantly managed right sided CDH. In agreement with our previous observation in prenatally diagnosed isolated left CDH with expectant management, 14 the overall survival in our study (28.6%) was lower to the overall survival in European and North American countries (53%-70%). 4,6,19,20 Similarly, our data showed a lower survival probability according to lung size in comparison to that previously published in European and North American countries.…”

Survival outcome in severe left‐sided congenital diaphragmatic hernia with and without fetal endoscopic tracheal occlusion in a country with suboptimal neonatal management

“…Notably, despite the technical success in the placement and removal of the balloon, the observed survival rate in our FETO group (32%) was lower than that in previous studies 7,8,[16][17][18] reporting survival rates ranging from 38% to 67%, and there were no survivors in the control group without FETO. This finding could be explained by the potentially higher neonatal mortality that has been described in CDH fetuses managed in countries in which termination of pregnancy is illegal and neonatal management is considered suboptimal 11 . It could be argued that differences in the NICU capabilities, such as unavailability of ECMO therapy, may also explain our lower survival rate.…”

“…This matching approach involves the formation of pairs of treated cases and controls with similar confounder variables, allowing a proper outcome comparison in the matched sample 9 . Although a randomized controlled trial 10 in fetuses with severe CDH with and those without FETO is ongoing, there are currently no data describing the survival of CDH fetuses treated with FETO in a country in which there is no option for legal termination of pregnancy in combination with suboptimal postnatal management, and thus a high neonatal mortality rate 11 .…”

Impact of fetal endoscopic tracheal occlusion in fetuses with congenital diaphragmatic hernia and moderate lung hypoplasia

“…This finding could be explained by the potentially higher neonatal mortality that has been described in CDH fetuses managed in countries where termination of pregnancy is not allowed, and neonatal management is considered suboptimal. 6 The main strength of our study is that was prospectively conducted and included a well-selected cohort of fetuses with isolated left sided CDH treated with FETO. The cohort was matched to a control group selected from a random sample based on severity of lung hypoplasia.…”