EP09.06: Prenatal diagnosis and perinatal outcome in congenital diaphragmatic hernia

Abstract

Objectives:The single umbilical artery (SUA) occurs between 0.2 to 1.9% of births and is associated with major malformations, aneuploidies, IUGR and perinatal death. The objective was to determine these in a large metropolitan Hospital in Santiago. Methods: Retrospective study of women that delivered in Padre Hurtado Hospital, Santiago, Chile. Data was extracted from computer ultrasound databases, delivery database and epicrisis of 13,446 newborns. Association with all perinatal complications were studied. Results: There were 84 fetuses with SUA, with an incidence of 0.62%. From these, 62 (73.8%) were isolated and 22 (26.1%) were associated with malformations or aneuploidy. The average gestational age at delivery was 36 + 4 weeks (range 22-40) and preterm birth was reported in 25 cases (29.7%). Major cardiovascular malformations were found in 55%, genitourinary in 27%, CNS and musculoskeletal in18%. Seven cases were associated to chromosomal abnormalities. The overall perinatal mortality rate was 17.8%, 5 fetuses from the isolated SUA (10.2%) and 10 from SUA associated to malformations/aneuploidies 45%. IUGR was associated in 11.9% of cases. Conclusions:The presence of SUA is associated with increased rate of malformations, aneuploidies and perinatal death even in isolated cases but not to IUGR. These data supports a closer surveillance in fetuses with this condition. Objectives: Congenital diaphragmatic hernia (CDH) is a challenging congenital anomaly to overcome lung hypoplasia. Although extensive efforts continue to be made to predict lung hypoplasia, no parameter has provided exact correlation with perinatal outcome. Our purpose was to determine the useful parameter to predict the outcome in CDH fetuses. Methods: 15 fetuses with CDH were evaluated retrospectively from January 2012 to February 2015. Observed/ expected lung to head circumference ratio (o/e LHR), diameter of pulmonary arteries (PA) and PA Doppler parameters including acceleration time/ ejection time ratio (AT/ET), peak early diastolic reverse flow (PEDRF) and pulsatility index (PI) were obtained. Lung-to-liver signal intensity ratio (LLSIR) was also measured on fetal MRI. We compare the validity of each parameter to neonatal survival, nitric oxide (NO) use after surgery and intubation periods. Results: In neonatal survival, o/e LHR and PA size had significant differences (p < 0.01, p < 0.05, respectively). In lethal cases, 3 in 5 had liver-up although no liver-up was found in survival cases. Lower LLSIR showed a trend to worse neonatal mortality (p = 0.06). PA size was only significant in NO use (p < 0.01) although PI showed a good trend (p = 0.07). Regarding intubation period, shorter AT/ET showed a good correlation to longer intubation period (r = 0.79, p < 0.05) and lower LLSIR had a trend to longer intubation period (r = −0.72, p = 0.07). Conclusions: Two dimensional evaluation might be a good predictor to neonatal mortality. Indeed Doppler parameters, especially AT/ET, might be useful for prediction of neonatal respiratory outcome in lung ...

Prognostic factors of death in children during the first year of life due to congenital diaphragmatic hernia: analysis of a hospital cohort from 2005 to 2015

“…Thus, these data corroborate those of most authors, who identified that the gestational age at the prenatal diagnosis was between 19 and 29 weeks. 10 , 12 , 13 , 14 …”

Primary Combined Latissimus Dorsi and Serratus Anterior Flap Repair of Right-Sided Congenital Diaphragmatic Agenesis in a Neonate

“…[2][3][4][5][6][7]9 In 98% of reported cases, CDA is a left-sided defect with a high mortality rate of 85-95%. [3][4][5][6][7] Right-sided CDA has a high mortality rate in comparison to right-sided CDH (95-98% versus 50-70%).…”

“…[2][3][4][5][6][7]9 In 98% of reported cases, CDA is a left-sided defect with a high mortality rate of 85-95%. [3][4][5][6][7] Right-sided CDA has a high mortality rate in comparison to right-sided CDH (95-98% versus 50-70%). [2][3][4][5][6][7]9,10 The present report details a unique case of right-sided CDA with complete hemidiaphragmatic agenesis associated with impaired development of the thoracic intercostal muscles and oesophageal mesentery.…”

“…[3][4][5][6][7] Right-sided CDA has a high mortality rate in comparison to right-sided CDH (95-98% versus 50-70%). [2][3][4][5][6][7]9,10 The present report details a unique case of right-sided CDA with complete hemidiaphragmatic agenesis associated with impaired development of the thoracic intercostal muscles and oesophageal mesentery. The defect was repaired using an autologous living bio-tissue flap to facilitate the development of a compliant neo-diaphragm that would provide effective pleuroperitoneal separation.…”

Possible Prevention of Neonatal Death: A Regional Population-Based Study in Japan

“…In addition, by analyzing the relation to perinatal diagnosis and end-of-life care in congenital abnormality, we found that none of prenatally diagnosed CDH or CHD received primary non-invasive care although the majority of prenatally diagnosed congenital abnormalities did. Neonatal survival in CDH and CHD with prenatal diagnosis was 38–70% 11 and 71–90%, 12 13 respectively. Based on the relatively high survival rate of these two maladies, intensive care for them with prenatal diagnosis is generally acceptable in our society.…”