Re‐evaluation of stomach position as a simple prognostic factor in fetal left congenital diaphragmatic hernia: a multicenter survey in Japan

Abstract

Objectives To document outcome and to explore prognostic factors in fetal left congenital diaphragmatic hernia (CDH). Methods

Improving the Prediction of Neonatal Outcomes in Isolated Left‐Sided Congenital Diaphragmatic Hernia by Direct and Indirect Sonographic Assessment of Liver Herniation

“…13 The stomach position was categorized as grades 0 to 3 on a coronal view according to the classification of Kitano et al 14 and as grades 1 to 4 on the 4-chamber view of the heart according to the classification of Cordier et al 15 The stomach position according to the Cordier classification was evaluated on the same image on which the lung-to-head ratio and liver-to-thorax ratio were measured. Only 1 sonographic examination per patient (the first examination) at our center was considered for analysis.…”

“…13 Investigators have also shown that the stomach position in the fetal chest can be considered an indirect method to quantify the degree of liver herniation, which also correlates with prognosis. [14][15][16] To our knowledge, there is no study comparing direct and indirect methods for quantifying liver herniation using conventional sonography. Conventional sonography is already widely used by maternal-fetal specialists to calculate the lung-to-head ratio, which is the measurement most often used to predict outcomes in fetuses with leftsided CDH.…”

Predictors of Mortality and Morbidity in Infants with CDH

“…In a recent CDH series, newborns with the liver up had a mortality of approximately 55%, and 80% of CDH children born with intrathoracic liver position required extracorporeal membrane oxygenation (ECMO) (Hedrick et al, 2007). Intact discharge rates when the liver is down was shown to be 87%, while when the liver is up it ranged from 10%-47% (Kitano et al, 2011). As liver position is a predictor of severity, it is not surprising that liver herniation is not only predictive of survival but also predicts impaired neurodevelopmental outcome.…”

Congenital Diaphragmatic Hernia: State of the Art Reconstruction- Biologics Versus Synthetics

“…Prenatally the degree of visceral herniation has been a good proxy for the size of the defect: the grade of herniation of the stomach into the chest (Kitano et al, 2011), herniation of the liver into the chest (Mullassery et al, 2010), herniation of the liver combined with the LHR for prediction of ECMO usage and mortality (Hedrick et al, 2007). All these prenatal measurements are used as predictors of outcome and are the best proxies for the size of the defect and the severity of underlying pulmonary hypertension.…”