Prenatal prognostic factors for isolated right congenital diaphragmatic hernia: a single center’s experience

Abstract

Background Right-sided congenital diaphragmatic hernia (RCDH) is relatively rare compared with left-sided congenital diaphragmatic hernia (LCDH). Clinical data of RCDH, especially with respect to antenatal prediction of neonatal outcome, are lacking. The aim of this study was to report the treatment outcomes of patients with antenatally diagnosed RCDH and to evaluate the predictability of observed-to-expected lung area-to-head circumference ratio (O/E LHR) for perinatal outcomes, focused on mortality or extracorporeal membrane oxygenation (ECMO) requirement. Methods We retrospectively reviewed the medical records of newborn infants with isolated RCDH. We analyzed and compared the clinical and prenatal characteristics including the fetal lung volume, which was measured as the O/E LHR, between the survivors and the non-survivors. Results A total of 26 (66.7%) of 39 patients with isolated RCDH survived to discharge. The O/E LHR was significantly greater in survivors (64.7 ± 21.2) than in non-survivors (40.5 ± 23.4) (P =.027). It was greater in survivors without ECMO requirement (68.3 ± 15.1) than non-survivors or those with ECMO requirement (46.3 ± 19.4; P = .010). The best O/E LHR cut-off value for predicting mortality in isolated RCDH was 50. Conclusions The findings in this study suggest that O/E LHR, a well-characterized prognostic indicator in LCDH, could be applied to a fetus with antenatally diagnosed RCDH. A large cohort study is required to verify the association between O/E LHR values and the graded severity of RCDH.

Two cases of right congenital diaphragmatic hernia with stable respiratory condition: Two case reports

“…A large diaphragmatic defect and massive herniation of abdominal viscera compresses the fetal lung, affecting its development. Additional prognostic factors in CDH are fetal development and lung volume [ 10 ], especially in case of liver herniation [ 20 ]. Liver herniation into the right chest cavity was observed in both our cases.…”

“…Recent nationwide cohort study performed in France also reported the survival rate was 57 % for rCDH and 77 % for lCDH with statistical difference ( P < .01) [ 6 ]. However, late-onset rCDH has also been reported [ 9 ], and some recent studies found no significant difference in mortality or morbidity if lung volume was sufficient and appropriate treatment was performed [ 4 , 7 , 10 ].…”

The upper airway parameters: the potential diagnostic clues for congenital intrathoracic lesions

“…Meanwhile, the upper airway parameters, influenced by biomechanics and lung liquid, might reflect true lung function. Some scholars once believed that the LHR only has prognostic value in left-sided CDH [ 32 ], however, recent research indicates that LHR can also be used for right diaphragmatic hernia [ 37 ]. Meanwhile, the upper airway parameters may be associated with overall lung development, thereby possessing prognostic value for potentially all types of CDH.…”

Prenatal diagnosis of right-sided congenital diaphragmatic hernia

“…RSCDH are linked to a higher mortality rate, often attributed to larger defect sizes. Research also indicates that the defect's size, rather than its lateralisation, plays a more pivotal role in determining the prognosis [5][6][7] (Table 1).…”