Impact of prenatal evaluation and protocol-based perinatal management on congenital diaphragmatic hernia outcomes |
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Authors: | Lazar David A Cass Darrell L Rodriguez Manuel A Hassan Saif F Cassady Christopher I Johnson Yvette R Johnson Karen E Johnson Anthony Moise Kenneth J Belleza-Bascon Bella Olutoye Oluyinka O |
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Institution: | a Texas Children's Fetal Center, Texas Children's Hospital, Houston, TX, USAb Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USAc Department of Pediatric Radiology, Texas Children's Hospital, Houston, TX, USAd Section of Neonatology, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USAe Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA |
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Abstract: | Background/PurposeAlthough intuitive, the benefit of prenatal evaluation and multidisciplinary perinatal management for fetuses with congenital diaphragmatic hernia (CDH) is unproven. We compared the outcome of prenatally diagnosed patients with CDH whose perinatal management was by a predefined protocol with those who were diagnosed postnatally and managed by the same team. We hypothesized that patients with CDH undergoing prenatal evaluation with perinatal planning would demonstrate improved outcome.MethodsRetrospective chart review of all patients with Bochdalek-type CDH at a single institution between 2004 and 2009 was performed. Patients were stratified by history of perinatal management, and data were analyzed by Fisher's Exact test and Student's t test.ResultsOf 116 patients, 71 fetuses presented in the prenatal period and delivered at our facility (PRE), whereas 45 infants were either outborn or postnatally diagnosed (POST). There were more high-risk patients in the PRE group compared with the POST group as indicated by higher rates of liver herniation (63% vs 36%, P = .03), need for patch repair (57% vs 27%, P = .004), and extracorporeal membrane oxygenation use (35% vs 18%, P = .05). Despite differences in risk, there was no difference in 6-month survival between groups (73% vs 73%).ConclusionsPatients with CDH diagnosed prenatally are a higher risk group. Prenatal evaluation and multidisciplinary perinatal management allows for improved outcome in these patients. |
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Keywords: | Congenital diaphragmatic hernia Prenatal diagnosis Multidisciplinary Perinatal management |
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