Liver Position Is a Prenatal Predictive Factor of Prosthetic Repair in Congenital Diaphragmatic Hernia

Abstract

Objective: To determine whether any common maternal-fetal variable has prenatal predictive value of prosthetic repair in congenital diaphragmatic hernia. Methods: This was a 5-year single-center retrospective review of fetal congenital diaphragmatic hernia referrals. Multiple prenatal variables were correlated with the need for a prosthetic repair. Statistical analyses were by Fisher’s exact and Mann-Whitney U-tests, as appropriate (p < 0.05). Results: Fetal liver position was a predictor of prosthetic repair. The presence or absence of liver herniation was correlated with prosthetic repair rates of 83.3 and 23.1%, respectively (p < 0.001). All patients with moderate/severe liver herniation required a prosthetic patch. Conclusion: Liver herniation has prenatal predictive value for the need for prosthetic repair in congenital diaphragmatic hernia. This finding should be valuable during prenatal counseling for clinical trials of engineered diaphragmatic repair.

Fetal lung volume and quantification of liver herniation by magnetic resonance imaging in isolated congenital diaphragmatic hernia

“…Liver herniation has long been considered an indicator of poor prognosis in fetuses with CDH. However, even though there is wide variation in the amount of liver herniated into the thorax, in most prior studies liver position has been considered to be solely a dichotomous variable (absent or present) which presents an analytical limitation.…”

Does the ex utero intrapartum treatment to extracorporeal membrane oxygenation procedure change outcomes for high-risk patients with congenital diaphragmatic hernia?

“…Many studies have examined ways to predict high-risk patients and mortality [13,14], but there have been very few convincing demonstrations that the high mortality associated with the highest risk patients can be ameliorated. Our inclusion criteria of looking at percentage of PLV less than 15% accurately predicated high risk.…”

Antenatal management of isolated congenital diaphragmatic hernia today and tomorrow: ongoing collaborative research and development

“…Use of patch also increases the number of ventilator days and hospital stay and increases the risk of gastroesophageal reflux [56,57]. In the prenatal period, retrospective studies have shown that the need for a patch can be predicted by herniation of the liver as well as the O/E LHR [21,57,58]. In the CDH antenatal registry, prenatal liver herniation occurred in 42% of infants requiring patch repair compared with 17% of those primarily repaired [21].…”