OC14.02: Lung-to-head ratio and liver position to predict outcome in early diagnosed isolated left sided diaphragmatic hernia fetuses: a multicenter study

DIAGNOSED ISOLATED LEFT SIDED DIAPHRAGMATIC HERNIA FETUSES: A MULTICENTER STUDY JACQUES JANI, ALEXANDRA BENACHI, RENE FAVRE, ROBERTA KELLER, HILDE VANDECRUYS, JULIAN DELGADO, MICHAEL HARRISON, JACQUELINE MATIS, EDUARD GRATACOS, KYPROS NICOLAIDES, JAN DEPREST, University Hospital Gasthuisberg, Obstetrics and Gynecology, Leuven, Belgium, Hopital Necker-Enfants Malades, Obstetrics and Gynaecology, Paris, France, CHRU Strasbourg, Obstetrics and Gynecology, Schiltigheim, France, University of California, San Francisco, Neonatology/Pediatrics, San Francisco, California, King’s College London, Harris Birthright Research Centre, London, United Kingdom, Hospital Universitari Vall Hebron, Obstetrics and Gynecology, Barcelona, Spain, University of California, San Francisco, Surgery & Pediatrics, San Francisco, California, CHRU Strasbourg, Neonatology, Schiltigheim, France OBJECTIVE: Congenital diaphragmatic hernia (CDH) is associated to high neonatal mortality. Accurate prediction of outcome is crucial in counselling parents about management options. We evaluated Lung-to-Head Ratio (LHR) and liver position in prediction of outcome of isolated Left CDH. STUDY DESIGN: Retrospective review of consecutive patients diagnosed with isolated LCDH %28 weeks, evaluated at 6 tertiairy units from 1995 onwards. Only patients with LHR measurements by experienced sonographers and with known liver position by ultrasound or MRI, both %28 wks, were included. Outcome measure was survival at discharge from NICU. RESULTS: 134 cases had an LHR obtained at 24.4 G 2.8 wks. 11 patients (8%) opted for termination after evaluation, all with LHR !1.4. There were no postnatal diagnoses of chromosomal anomalies. Overall survival was 43% (58/ 134), after substraction of antenatal losses 47% (58/123). In case of liver herniation survival was 35 %. LHR correlated to survival irrespective of liver position but combination of both variables predicted neonatal outcome better: liver up & LHR !1 predicted a survival of 9%. When LHR !0.8 and liver up, there were no survivors, but with liver down (37% of cases) survival was 40%. When LHR !0.6 there were no survivors irrespective of liver position. CONCLUSION: Combination of liver up& LHR !1 at %28 wks predicts a !10 % chance of survival, dropping to 0% if LHR !0.8. 8% of patients opted for termination after second opinion, all with LHR !1.4, but only in half this coincided with the above poor prognostic indicators.