Ultrasound Obstet Gynecol. 2020 Jul 1. doi: 10.1002/uog.22133. [Epub ahead of print] https://pmlegacy.ncbi.nlm.nih.gov/pubmed/32610372
Optimal gestational age at delivery for congenital diaphragmatic hernia.
Bouchghoul H1,2, Dumery G1, Russo FM3,4, Cordier AG2,5, Le Sache N2,6, Debeer A7, Decaluwé H8, Fouquet V9, Senat MV1,2, Deprest J3,4, Benachi A2,5.
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Abstract
OBJECTIVE:
To evaluate the neonatal morbidity and mortality of babies with isolated congenital diaphragmatic hernia (CDH) according to gestational age at delivery.
METHODS:
We conducted a retrospective study in the University Hospitals of Antoine Béclère-Bicêtre and Leuven between January 1, 2010 and December 31, 2018. Isolated left-sided CDH cases were included. The Kaplan-Meier method was used to calculate cumulative survival at 28 days according to gestational age at delivery. The association between gestational age at delivery, as a continuous variable, and survival at 28 days was modeled using a fractional polynomial. Adjustment for position of the liver, management center, and mode of delivery was performed. The association was studied according to the severity of the CDH, defined by the o/e LHR, categorized in three classes: below 25%, between 25 and 45%, above 45%.
RESULTS:
We included 213 fetuses with isolated left-sided CDH, with a median gestational age at delivery of 38+2 WG [IQR: 37+0 -39+6 ]. Survival rates at 28 days and 6 months were 66.7% (142/213) and 64.3% (137/213), respectively. Kaplan-Meier curves showed higher survival up to 28 days for babies born between 37+0 and 39+0 WG than for those born after 39+0 WG (log-rank test, p<.001). In the subgroup of moderate forms, the survival rates at 28 days and 6 months were significantly higher for newborns delivered between 37+0 and 39+0 WG, compared to newborns delivered after 39+0 WG: 81.5% vs 61.5% (p=0.03). In this subgroup, 28-day survival significantly increased with advancing gestational age at birth until 38-39 WG (p=0.005) and significantly decreased from 39 WG.
CONCLUSIONS:
Delivery between 37+0 and 39+0 WG is associated with a higher survival rate at 28 days of life for moderate forms independently of intrathoracic liver, management center, and mode of delivery. This article is protected by copyright. All rights reserved.
This article is protected by copyright. All rights reserved.
KEYWORDS:
Congenital diaphragmatic hernia; gestational age at delivery; moderate forms; prognosis; respiratory morbidity; survivalPMID: 32610372 DOI: 10.1002/uog.22133
