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Q&A

Fetus

Poster Session 4

(1162) Prenatal predictors of survival in isolated congenital diaphragmatic hernia undergoing expectant management

Wednesday, February 14, 2024

1:00 PM – 2:30 PM

Location: Prince George's Exhibit Hall CDE, Lower Atrium Level

Primary & Presenting Author(s)

Alena Tofte, MD, MPH (she/her/hers)

Dartmouth Hitchcock Medical Center
Lebanon, NH

Coauthor(s)

FA

Faezeh Aghajani, MD

BCNatal Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, Universitat de Barcelona
Barcelona, Islas Baleares, Spain
MJ

Mohammad Jawwad, MD

Dow University of Health and Sciences
Karachi, Sindh, Pakistan
AF

Anna Flood, BS

Indiana University School of Medicine
Indianapolis, IN, United States
FD

Francesco D'Antonio, MD, PhD, FRCOG, MBBS, MSc

McMaster University
Hamilton, ON, Canada
Asma Khalil, MD, MSc (she/her/hers)

Professor of Maternal Fetal Medicine
Fetal Medicine Unit, St. George's Hospital, St. George's University of London
London, England, United Kingdom
Hiba J. Mustafa, MD (she/her/hers)

Assistant Professor of Fetal Surgery and Maternal-Fetal Medicine
Indiana University, Riley Children's Hospital
Carmel, IN, United States

Objective: To investigate prenatal predictors of survival to hospital discharge in fetuses with isolated congenital diaphragmatic hernia (CDH) undergoing prenatal expectant management.

Study Design: We performed a systematic review and meta-analysis on prenatal diagnostic tests in fetuses with isolated CDH undergoing expectant management. Cases undergoing FETO were excluded. Primary outcome was survival to hospital discharge. Subgroup analysis was performed according to the side of CDH when feasible. Pooled effect sizes were presented using mean difference (MD) or odds ratio (OR), using the Mantel-Haenszel test, with 95% confidence interval (CI) for continuous and categorical variables, respectively.

Results:

A total of 161 full text articles were assed for eligibility between 2000 and 2023. Forty-five studies encompassing 3977 isolated CDH were included. Pooled proportion for survival was 71.2%, (95% CI 69.8%-72.6%). Index tests that were significantly associated with survival included: 1) Total fetal lung volume (TFLV) (MD 13.42, 95% CI 11.22, 15.62), 2) o/e TFLV < 30% (OR 0.09 , 95% CI 0.05, 0.17), 3) o/e TFLV (MD 14.73, 95% CI 11.62,17.84, I2 46%), 4) Liver intra-thoracic ratio (LiTR) (MD 9.59, 95% CI -15.73,-3.46), 5) o/e LHR (MD 14.03, 95% CI 12.69, 15.36), 6) o/e LHR < 25% (OR 0.07, 95% CI 0.04, 0.13), 7) Mediastinal shift angle (MD -6.17, 95% CI -7.70,-4.64), 8) Stomach position in mid-chest (OR 0.14, 95% CI 0.06, 0.36), and 9) intrathoracic liver (OR 0.23, 95% CI 0.15, 0.35), subgroup analysis to the left side remained significant in all the aforementioned tests.

Conclusion: In fetuses with CDH, fetal lung size measurements by ultrasound including LHR cut-off of 25% or MRI including TFLV cut-off of 30%, and liver herniation are good predictors for survival in isolated CDH.