A. C. Akinkuotu1,2, S. Cruz1,2, D. Cass1,2,4,5, T. Lee1,2, C. Cassady1,3, A. Mehollin-Ray1,3, J. Williams1,3, R. Ruano1,4, S. Welty1,5, O. Olutoye1,2,4,5 1Texas Children’s Hospital,Texas Children’s Fetal Center,Houston, TX, USA 2Baylor College Of Medicine,Michael E. DeBakey Department Of Surgery,Houston, TX, USA 3Baylor College Of Medicine,Department Of Radiology,Houston, TX, USA 4Baylor College Of Medicine,Department Of Obstetrics And Gynecology,Houston, TX, USA 5Baylor College Of Medicine,Deparment Of Pediatrics- Newborn Section,Houston, TX, USA
Introduction:
Studies comparing outcomes of right-sided (R-CDH) and left-sided (L-CDH) congenital diaphragmatic hernia are conflicting, though most suggest R-CDH is associated with higher morbidity and mortality than those with left-sided lesions. The purpose of this study was to examine the effect of right-sidedness on outcomes, particularly pulmonary morbidity, in neonates with CDH. We hypothesized that neonates with R-CDH would have worse short-term pulmonary morbidity compared to those with L-CDH.
Methods:
A retrospective review of all neonates with CDH diagnosed at a tertiary children’s hospital between January 2004 and January 2014 was performed. Patient characteristics and outcomes were compared between R-CDH and L-CDH. In cases of prenatally diagnosed CDH, lung volumes were measured by fetal MRI-based calculations of the observed-to-expected total fetal lung volume (O/E- TFLV). A subgroup analysis was performed for patients with isolated CDH. Statistical analyses were performed using the Mann -Whitney test for continuous variables and Fischer’s Exact test for categorical variables.
Results:
Of 169 CDH patients; 37 (21.9 %) were R-CDH and 132 (78.1%) were L-CDH. Fetuses with R-CDH were diagnosed at a later gestational age (29.5±8.5vs. 23.5±5.6 weeks; p<0.001) compared to those with L-CDH. Of fetuses evaluated with fetal MRI (13 R-CDH, 91 L-CDH), there was no difference in O/E-TFLV between those with R-CDH and L-CDH (30.9±11.2% vs. 33.9±14.5%; p=0.471). There was no difference in the median duration of intubation (10 vs. 12 days; p=0.697), hospital stay (53 vs. 46 days; p=0.927), or need for oxygen at 30 days of life (51.7% vs. 46.1%;p=0.679) between groups. Furthermore, there was no statistical difference in the use of ECMO (40.5% vs. 30.5%; p=0.321) or 6-month mortality (27.0%vs.19.7%; p=0.366) between groups. When we examined outcomes in those with isolated CDH alone (n=128), we found a lower incidence of prenatal diagnosis and inborn status in those with R-CDH (41% v 77%, p=0.001 and 59% v. 78%, p=0.081, respectively). For those with isolated R-CDH, ECMO was used nearly twice as often compared to those with L-CDH (Table).
Conclusion:
Fetuses with R-CDH are less likely to be diagnosed prenatally and thus have a higher need for ECMO and higher mortality. Otherwise, the sidedness of the hernia defect appears to have no effect on short-term pulmonary morbidity in a large, contemporary single-institution experience of neonates with intrapleural CDH.
