Prognosis of Congenital Diaphragmatic Hernia

Abstract

Congenital diaphragmatic hernia (CDH) contributes significantly to perinatal morbidity and mortality. This retrospective study examines the experience of a major teaching hospital to establish survival rates and factors influencing outcome. Survival rates were found to relate closely to the stage at which the diagnosis was made and the presence of associated anomalies. Ultrasound diagnosis early in pregnancy is associated with a higher mortality rate than diagnosis made late in pregnancy or after delivery. Logistic regression analysis and chi-squared analysis did not establish to a significant degree that any factor, alone or in combination, was a reliable prognostic indicator. It is acknowledged, however, that figures in this series are small. Survival figures are presented to facilitate reliable parental counselling. In particular, the presence of associated major anomalies and the gestational age at which diagnosis is made are of critical importance in accurately counselling parents regarding the prognosis for survival. In this study, excluding terminations, the mortality rate for isolated CDH diagnosis before the 21st week was 45.5%, with a corresponding survival rate of 54.5%. Once the infant was liveborn, however, the survival rate rose to 68.0%, and if the infant survived transfer to a paediatric surgical unit, the survival rate in this study was 73.9 %.

Reported multivitamin consumption and the occurrence of multiple congenital anomalies

“…MCA were identified in about 16 per 10,000 live births in metropolitan Atlanta from 1968 to 1989; however, 13% of the infants with MCA ascertained in metropolitan Atlanta in 1988–89 had identified chromosomal abnormalities [Khoury et al, 1991]. Infants with MCA usually require extensive and frequent medical care; their morbidity and mortality are substantially higher than that for infants with isolated anomalies [Putnam, 1979; Iuchtman et al, 1992; Engum et al, 1995; Moore et al, 1998; Heider et al, 2004]. Based on previous epidemiologic studies that have identified different risk factors for infants with isolated defects as compared with multiple major defects [Khoury et al, 1982a,b, 1989; Botto et al, 1996; Moore et al, 1997], we assume that the etiology for infants with MCA is different than that for infants with one isolated defect.…”

Patterns of cerebral injury in a series of infants with congenital diaphragmatic hernia utilizing magnetic resonance imaging

“…1 The mortality rate for isolated CDH diagnosed before the 21st week has been reported as 45%. 2 Approximately half of all cases of CDH occur as isolated malformations, and, in these cases, brain development is assumed to be normal with neurodevelopmental outcome for these infants being viewed optimistically. For the remaining 50% of infants with a coexisting anomaly, approximately 7% will have anomalies of the central nervous system.…”

Prenatal ultrasound diagnosis of congenital diaphragmatic hernia and meningomyelocele: a case report with literature review

“…In a German study of children with MMC, the sensitivity of prenatal ultrasound increased from 0 to 37% between 1982 and 1990 with a mean detection rate of 27% (18). Higher prenatal detection rates of CDH (53%-87%) have also been reported in recent population-based studies (9,19).…”