ANTENATAL DIAGNOSIS OF ISOLATED CONGENITAL DIAPHRAGMATIC-HERNIA IS NOT AN INDICATOR OF OUTCOME

It has been reported previously that infants diagnosed with congenital diaphragmatic hernia (CDH) antenatally have a much poorer prognosis than those diagnosed postnatally. The authors identified 173 high-risk (symptomatic within the first 6 hours of life) infants with CDH treated in the past decade. Seventy-seven cases were diagnosed antenatally and 96 were diagnosed postnatally. The survival rate was slightly worse for the antenatal group (34% v 48% for the postnatal group; P = .04). However, 59 of the 173 patients (34%) had other life-threatening congenital anomalies. Among the 114 patients with isolated CDH, the survival rate increased to 59% in the antenatal group and 63% in the postnatal group-a difference that was not significant. The timing of antenatal diagnosis (> or <25 weeks) had no impact on the statistics (P = .08). The only parameter consistently different between all groups and subgroups was the Apgar score at 5 minutes, which was always better in the antenatal group (P < .02), possibly reflecting more efficient resuscitation. Of the 59 patients with other life-threatening anomalies (42 cardiac), there was one survivor among the 34 in the antenatal group and only two among the 25 in the postnatal group, despite the fact that 39 patients had undergone resuscitation, which included ECMO in 25. From these data the authors conclude that (1) antenatal diagnosis of an isolated CDH, regardless of its timing (< or > 25 weeks), is of no value in predicting outcome; (2) survival for patients with antenatally diagnosed isolated CDH is much higher than previously reported, a fact that should be considered when antenatal manipulations such as in utero CDH repair or termination of pregnancy are contemplated; (3) awareness of CDH by antenatal diagnosis leads to more effective resuscitation after birth; and (4) CDH associated with another significant anomaly, especially cardiac, currently has a dismal prognosis, irrespective of timing of diagnosis. © 1994.