Prenatal diagnosis and fetal outcome of 57 cases of congenital diaphragmatic hernia

Abstract

Objective To explore the prenatal diagnosis and factors influencing prognosis of congenital diaphragmatic hernia (CDH).Methods Fifty seven cases of CDH prenatally diagnosed by ultrasound in the Department of Obstetrics,Xinhua Hospital from January 1,2006 to March 31,2013 were retrospectively reviewed.Prognosis and risk factors were analyzed by ultrasound characteristics and newborn status.Statistical analysis was performed using t test,x2 test and Logistic regression.Results Forty-five (79％)of all cases were left-side CDH and the rest 12 (21％)were right-side.Fourteen fetuses were aborted.Thirty three were delivered and treated surgically,twenty-three infants survived after surgery and ten died,with an overall survival rate of 40％ (23/57).The other ten cases were delivered,but died of no treated surgically.The birth weight of the surviving neonates was heavier than that of those who died [(3 173 ±348) vs (2 846±568)g,t=2.238,P=0.033].The gcstational age at diagnosis of the aborted fetuses was younger than that of the surviving neonates [(24.0 ± 4.1) vs (30.0± 6.0) weeks,t=3.181,P=0.003].Twenty-one (91％,21/23) of the surviving neonates had a lung-to-head ratio (LHR) ≥ 1.4.A linear trend test showed a negative correlation between LHR and adverse outcome (x2=9.223,P=0.002) with a correlation coefficient-0.730 (P=0.000).LHR＜1.4 (OR=35.867,95％CI:1.861-691.341,P=0.018) and polyhydramnios (OR=9.285,95％CI:1.102-78.212,P=0.040) were risk factors for neonatal death.Right-side CDH (OR=0.158,95％CI:0.009-2.824,P=0.210),liver herniation into the thorax (OR=1.730,95％CI:0.144 20.707,P=0.665) and birth weight (OR=l.002,95％CI:0.999-1.005,P=0.135) were not risk factors.Conclusions The survival rate of CDH is still low.Gestational age on diagnosis,presence of polyhydramnios and LHR＜ 1.4 predict an adverse outcome. Key words: Hernia, diaphragmatic; Ultrasonography, prenatal; Prognosis