Congenital diaphragmatic hernia: A meta-analysis of mortality factors

Skari, Hans; Björnland, Kristin; Haugen, Guttorm; Egeland, Thore; Emblem, Ragnhild

doi:10.1053/jpsu.2000.8725

Cited by 357 publications

(295 citation statements)

References 104 publications

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“…Nevertheless, in our series, rightsided lesion as well as major mediastinal shift and herni- ated liver were more frequently observed in neonates who died before 7 days of life, and these factors have also been related to a poorer outcome in other studies. 1,5,7,16 By analyzing the natural history of CDH, the present study is important for demonstrating that each hospital may experience different neonatal mortality rates in isolated CDH. It also motivates us to review our neonatal care and our prenatal evaluation of prognosis as well as to consider fetal interventions in selected cases.…”

Section: Discussionmentioning

confidence: 99%

“…1,2 Herniated abdominal structures, such as stomach and liver, shift fetal lungs, and cause pulmonary hypoplasia, which is responsible for the high neonatal mortality rate. 3 Although the lungs are shifted during fetal life, the placenta maintains respiratory function, allowing correct gas exchange.…”

Section: Introductionmentioning

confidence: 99%

“…6 Nowadays, the mortality rate has been decreasing among neonates with isolated CDH, varying from 40% to 75% in developed countries. 1,7 Nevertheless, in spite of the great advances in prenatal and postnatal diagnosis and management, the mortality rate in neonates with isolated CDH is still high. 8 Recent research has focused on prenatal predictors of neonatal outcome in isolated CDH cases, such as lung/head ratio 9,10 and fetal lung volume, [11][12][13][14][15][16] to differentiate cases with a worse prognosis, in which fetal therapy or termination of pregnancy may be indicated, from those with better prognosis, requiring only specialized postnatal care.…”

Section: Introductionmentioning

confidence: 99%

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Prenatal Diagnosis and Perinatal Outcome of 38 Cases With Congenital Diaphragmatic Hernia: 8-Year Experience of a Tertiary Brazilian Center

Ruano

Bunduki

Silva

et al. 2006

Clinics

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diagnosis and perinatal outcome of 38 cases with congenital diaphragmatic hernia: 8-year experience of a tertiary Brazilian center. Clinics. 2006;61(3):197-202. PURPOSE:To evaluate the perinatal results for neonates with congenital diaphragmatic hernia diagnosed prenatally. METHOD: We reviewed data from 38 cases of congenital diaphragmatic hernia diagnosed prenatally from January 1995 to December 2003 in the Fetal Medicine Unit of the Department of Obstetrics and Gynecology, São Paulo University Medical School. The main data analyzed were gestational age at diagnosis, fetal karyotyping, side of diaphragmatic defect, presence of associated structural malformations, hepatic herniation, and severe mediastinal shift. Perinatal outcomes were obtained by reviewing hospital documents or by directly calling the patients' immediate relatives. RESULTS: Mean gestational age at diagnosis was 29 weeks (range, 16-37 weeks).Thirty (79%) cases had a left diaphragmatic defect and 8 (21%) had a right lesion. Associated structural malformations were observed in 21 (55%) cases, in which 12 fetuses had a normal karyotype and 9 had chromosomal abnormalities. Isolated congenital diaphragmatic hernia was confirmed in 17 (45%) cases. The overall perinatal mortality rate was 92%. Rates of fetal deaths, early neonatal deaths, late neonatal deaths, and survival were 42%, 50%, 0%, and 8%, respectively, in cases with associated structural malformations but normal karyotyping; 56%, 44%, 0%, and 0% for cases with chromosomal abnormalities; and, 0%, 76%, 12%, and 12% in cases with isolated congenital diaphragmatic hernia. The neonatal mortality rate was 89% in cases with isolated congenital diaphragmatic hernia. CONCLUSION: Perinatal mortality was very high in prenatally diagnosed cases of congenital diaphragmatic hernia. Earlier perinatal deaths are associated with the presence of other structural defects or chromosomal abnormalities. In cases of isolated congenital diaphragmatic hernia, mortality is related to the presence of herniated liver, right-sided lesion, and major mediastinal shift.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Prenatal Diagnosis and Perinatal Outcome of 38 Cases With Congenital Diaphragmatic Hernia: 8-Year Experience of a Tertiary Brazilian Center

Ruano

Bunduki

Silva

et al. 2006

Clinics

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“…Complete agenesis, herniation of the central tendoneous part and eventration are other rare manifestations. In around 40% of cases, there are associated anomalies, an independent predictor of neonatal death, with less than 15% of babies surviving in this group (Skari et al, 2000;Rottier and Tibboel, 2005). The majority, however, has an isolated defect.…”

Section: Introductionmentioning

confidence: 99%

Prenatal diagnosis, prediction of outcome and in utero therapy of isolated congenital diaphragmatic hernia

et al. 2008

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Congenital diaphragmatic hernia (CDH) can be associated with genetic or structural anomalies with poor prognosis. In isolated cases, survival is dependent on the degree of lung hypoplasia and liver position. Cases should be referred in utero to tertiary care centers familiar with this condition both for prediction of outcome as well as timed delivery. The best validated prognostic indicator is the lung area to head circumference ratio. Ultrasound is used to measure the lung area of the index case, which is then expressed as a proportion of what is expected normally (observed/expected LHR). When O/E LHR is <25% survival chances are <15%. Prenatal intervention, aiming to stimulate lung growth, can be achieved by temporary fetal endoscopic tracheal occlusion (FETO). A balloon is percutaneously inserted into the trachea at 26-28 weeks, and reversal of occlusion is planned at 34 weeks. Growing experience has demonstrated the feasibility and safety of the technique with a survival rate of about 50%. The lung response to, and outcome after FETO, is dependent on pre-existing lung size as well gestational age at birth. Early data show that FETO does not increase morbidity in survivors, when compared to historical controls. Several trials are currently under design.

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“…Although the etiology of this disease is poorly understood, both genetic and environmental factors are thought to play a role (4,5). Prior to surgical repair, mortality is directly related to the level of pulmonary hypertension (PH) (6). This has led to the development of different strategies aimed at relieving elevation of pulmonary artery (PA) pressures in the preoperative period, with a resulting improvement in survival.…”

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confidence: 99%

Pulmonary vascular resistance in repaired congenital diaphragmatic hernia vs. age-matched controls

et al. 2012

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Congenital diaphragmatic hernia: A meta-analysis of mortality factors

Cited by 357 publications

References 104 publications

Prenatal Diagnosis and Perinatal Outcome of 38 Cases With Congenital Diaphragmatic Hernia: 8-Year Experience of a Tertiary Brazilian Center

Prenatal Diagnosis and Perinatal Outcome of 38 Cases With Congenital Diaphragmatic Hernia: 8-Year Experience of a Tertiary Brazilian Center

Prenatal diagnosis, prediction of outcome and in utero therapy of isolated congenital diaphragmatic hernia

Pulmonary vascular resistance in repaired congenital diaphragmatic hernia vs. age-matched controls

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