Prenat Diagn. 2019 Apr 13. doi: 10.1002/pd.5458. [Epub ahead of print]
A multicenter study to predict neonatal survival according to lung-to-head ratio and liver herniation in fetuses with left Congenital Diaphragmatic Hernia (CDH): hidden mortality from the Latin American CDH Study Group Registry.
Cruz-Martínez R1, Etchegaray A2, Molina-Giraldo S3, Nieto-Castro B4, Gil Guevara E5, Bustillos J6, Martínez-Rodríguez M1, Gámez-Varela A1, Saldivar-Rodríguez D1, Chávez-González E1, Keller R2, Russo R2, Yepez-García E4, Coronel-Cruz F7, Torres-Torres J7, Rojas-Macedo A8, Ibarra-Ríos D9, Ordorica-Flores R9, Nieto-Zermeńo J9, Alcocer-Alcocer M1; Latin American CDH Study Group.
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To evaluate natural history of fetuses congenital diaphragmatic hernia (CDH) prenatally diagnosed in countries where termination of pregnancy is not legally allowed and to predict neonatal survival according to lung area and liver herniation.

Prospective study including antenatally diagnosed CDH cases managed expectantly during pregnancy in six tertiary Latin American centres. The contribution of the observed/expected lung-to-head ratio (O/E-LHR) and liver herniation in predicting neonatal survival was assessed.

From the total population of 380 CDH cases, 144 isolated fetuses were selected showing an overall survival rate of 31.9% (46/144). Survivors showed significantly higher O/E-LHR (56.5% vs. 34.9%; p<0.001), lower proportion of liver herniation (34.8% vs. 80.6%, p<0.001) and higher gestational age at birth (37.8 vs. 36.2 weeks, p<0.01) than non-survivors. Fetuses with an O/E-LHR <35% showed a 3.4% of survival; those with an O/E-LHR between 35-45% showed 28% of survival with liver up and 50% with liver down; those with an O/E-LHR >45% showed 50% of survival rate with liver up and 76.9% with liver down.

Neonatal mortality in CDH is higher in Latin American countries. The category of lung hypoplasia should be classified according to the survival rates in our Latin American CDH Registry.

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PMID: 30980408 DOI: 10.1002/pd.5458