Differences in Outcomes in Prenatally Diagnosed Congenital Diaphragmatic Hernia Compared to Postnatal Detection: A Single-Center Experience.

OBJECTIVES: To compare outcomes in pregnancies with a prenatal detection of congenital diaphragmatic hernia (CDH) with children diagnosed after birth, treated at the same institution, and to determine the ability to predict prognosis through measurements of the observed to expected lung-to-head ratio (O/E LHR). METHODS: This is a retrospective review of all children with CDH treated at our institution during 2006-2014. We compared outcomes of infants referred for surgery after postnatal diagnosis with outcomes of infants with prenatally diagnosed CDH. RESULTS: In the prenatal group, O/E LHR was significantly different between survivors and deceased patients, with a cutoff at 35% O/E LHR. Survival to discharge and 1-year survival were significantly higher in the postnatal group that required intubation within 24 h; i.e., 92 and 89% versus 85 and 73% in the prenatal group (p < 0.05). There was less need for extracorporeal membrane oxygenation (ECMO), 41 versus 60%, and patch, 41 versus 75% (p < 0.001), in the postnatal group with early diagnosis compared with the prenatal group, respectively. CONCLUSION: Children with prenatally diagnosed CDH represent a population with a more severe condition compared to infants diagnosed after birth. They have poorer outcomes with higher needs for ECMO or use of patch, and lower survival rates were observed at an O/E LHR below 35%.

[Routine pregnancy ultrasound scans can detect malformations. Multidisciplinary care of both the foetus and parent is required following diagnosed malformations]. / Rutinundersökning med ultraljud kan ge besked om avvikelser - Vid diagnostiserad missbildning krävs multidisciplinärt omhändertagande av både foster och föräldrar.

Routine pregnancy ultrasound scans can detect malformations. Multidisciplinary care of both the foetus and parent is required following diagnosed malformations In Sweden, all women are invited to at least one ultrasound examination during pregnancy. The ¼Routine ultrasound screening« is usually performed by a midwife around 18 weeks of gestation. There are several aims of the examination: to check viability, to detect multiple fetuses, to determine the location of the placenta, to check the amount of amniotic fluid, to estimate the date of delivery (if this had not been done earlier) and to detect structural fetal malformations. It is important to offer an adequate education for all providers and assure the quality of the examinations. Nationwide courses are offered once or twice a year, and as a goal, all providers should have a ¼certificate of competence« for this kind of examination. When a fetal malformation is suspected, confirmed after further investigations and the prospective parents decide to continue the pregnancy, multidisciplinary care is offered in cooperation with or at a university hospital.