PLPostnatal Imaging for Prediction of Outcome in Patients with Left-sided Congenital Diaphragmatic Hernia

Pyeong Hwa Kim¹, Hyunhee Kwon², Hee Mang Yoon³, Byong Sop Lee⁴, Euiseok Jung⁴, Mi-Young Lee⁵, Hye-Sung Won⁵, Dae Yeon Kim², Jung-Man Namgoong², Jin Seong Lee¹, Yunsun Song¹, Ah Young Jung¹, Young Ah Cho¹

Affiliations expand

PMID: 35944713
DOI: 10.1016/j.jpeds.2022.07.037

Abstract

Objective: To evaluate associations between postnatal imaging features and outcome of left-sided congenital diaphragmatic hernia (L-CDH) defined by overall survival and a requirement for extracorporeal membrane oxygenation (ECMO).

Study design: Newborns prenatally diagnosed with L-CDH between January 2013 and September 2021 were studied retrospectively. Esophageal deviation index was newly defined as the largest diameter from the midline to deviated gastric tube divided by the largest transverse diameter of the thoracic cavity on the radiograph. Regression analyses were performed to identify postnatal imaging features associated with overall survival and a requirement for ECMO. Predictive power, i.e., area under the curve (AUC) of a time-dependent receiver operating characteristic curve, of prenatal, postnatal, and intraoperative findings for predicting survival were calculated.

Results: 97 patients (54 male; mean gestational age, 38.3 ± 1.9 weeks; mean birth weight, 2956.5 ± 540.0 g) were analyzed. Esophageal deviation index (adjusted hazard ratio [HR]: moderate [≥0.19, <0.24], 6.427 [P = 0.029]; severe [≥0.24], 33.007 [P < 0.001]) and right pneumothorax (adjusted HR, 8.763; P = 0.002) were associated with overall survival, and also associated with a requirement for ECMO. Liver herniation on postnatal ultrasound (US) was also associated with overall survival (P <0.001) and a requirement for ECMO (P = 0.001). In addition, AUC for prediction of 1 year survival from postanatal US was comparable with prenatally or intraoperatively detected liver herniation (0.93; 95% CI, 0.88-0.97).

Conclusion: Esophageal deviation index, right pneumothorax, and liver herniation observed by postnatal imaging have prognostic value in patients with L-CDH.

Keywords: Congenital diaphragmatic hernia; Neonate; Radiograph; Survival; Ultrasound.

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Research: PLPostnatal Imaging for Prediction of Outcome in Patients with Left-sided Congenital Diaphragmatic Hernia

PLPostnatal Imaging for Prediction of Outcome in Patients with Left-sided Congenital Diaphragmatic Hernia

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