Decreased neonatal morbidity in ‘stomach‐down’ left congenital diaphragmatic hernia: implications of prenatal ultrasound diagnosis for counseling and postnatal management

• Published in: Ultrasound in obstetrics & gynecology 2021-11, Vol.58 (5), p.744-749
• Main Authors: Didier, R. A., Oliver, E. R., Rungsiprakarn, P., Debari, S. E., Adams, S. E., Hedrick, H. L., Adzick, N. S., Khalek, N., Howell, L. J., Coleman, B. G.
• Format: Article
• Language: English
• Subjects: Adult; Cephalometry; Chest; congenital diaphragmatic hernia; Diaphragm; Distension; Echocardiography; ECMO therapy; Female; Fetus - diagnostic imaging; Fetus - pathology; Fetuses; Gynecology; Head - diagnostic imaging; Head - pathology; Hernia; Hernias; Hernias, Diaphragmatic, Congenital - diagnostic imaging; Hernias, Diaphragmatic, Congenital - embryology; Hernias, Diaphragmatic, Congenital - pathology; Humans; Hypertension; Hypoplasia; Infant, Newborn; Infant, Newborn, Diseases - diagnostic imaging; Infant, Newborn, Diseases - embryology; Infant, Newborn, Diseases - pathology; Infants; Intestine; Intubation; Liver; Lung - diagnostic imaging; Lung - embryology; Lung - pathology; Lungs; Magnetic Resonance Imaging; Male; Medical diagnosis; Medical imaging; Medical records; Morbidity; Neonates; Newborn babies; Obstetrics; Oxygenation; Patients; Pregnancy; prenatal diagnosis; prenatal ultrasound; Pulmonary hypertension; pulmonary hypoplasia; Retrospective Studies; Stomach; Stomach - diagnostic imaging; Stomach - embryology; Stomach - pathology; Ultrasonic imaging; Ultrasonography, Prenatal; Ultrasound
• ISSN: 0960-7692; 1469-0705
• DOI: 10.1002/uog.23630

ABSTRACT Objective To evaluate the influence of stomach position on postnatal outcome in cases of left congenital diaphragmatic hernia (CDH) without liver herniation, diagnosed and characterized on prenatal ultrasound (US), by comparing those with (‘stomach‐up’ CDH) to those without (‘stomach‐down’ CDH) intrathoracic stomach herniation. Methods Infants with left CDH who underwent prenatal US and postnatal repair at our institution between January 2008 and March 2017 were eligible for inclusion in this retrospective study. Detailed prenatal US examinations, fetal magnetic resonance imaging (MRI) studies, operative reports and medical records of infants enrolled in the pulmonary hypoplasia program at our institution were reviewed. Cases with liver herniation and those with an additional anomaly were excluded. Cases in which bowel loops were identified within the fetal chest on US while the stomach was intra‐abdominal were categorized as having stomach‐down CDH. Cases in which bowel loops and the stomach were visualized within the fetal chest on US were categorized as having stomach‐up CDH. Prenatal imaging findings and postnatal outcomes were compared between the two groups. Results In total, 152 patients with left CDH were initially eligible for inclusion. Seventy‐eight patients had surgically confirmed liver herniation and were excluded. Of the 74 included CDH cases without liver herniation, 28 (37.8%) had stomach‐down CDH and 46 (62.2%) had stomach‐up CDH. Of the 28 stomach‐down CDH cases, 10 (35.7%) were referred for a suspected lung lesion. Sixty‐eight (91.9%) cases had postnatal outcome data available for analysis. There was no significant difference in median observed‐to‐expected (o/e) lung‐area‐to‐head‐circumference ratio (LHR) between cases with stomach‐down CDH and those with stomach‐up CDH (41.5% vs 38.4%; P = 0.41). Furthermore, there was no difference in median MRI o/e total lung volume (TLV) between the two groups (49.5% vs 44.0%; P = 0.22). Compared with stomach‐up CDH patients, stomach‐down CDH patients demonstrated lower median duration of intubation (18 days vs 9.5 days; P