Risk Stratification by Percent Liver Herniation in Congenital Diaphragmatic Hernia

Authors

Oluyinka O Olutoye
Steven C Mehl
Anoosha Moturu
Rowland W Pettit
Ryan D Coleman
Adam M Vogel
Timothy C Lee
Sundeep G Keswani
Alice King

Publication Date

2-1-2023

Journal

Journal of Surgical Research

DOI

10.1016/j.jss.2022.09.002

PMID

36306587

PMCID

PMC11132729

PubMedCentral® Posted Date

5-28-2024

PubMedCentral® Full Text Version

Author MSS

Published Open-Access

yes

Keywords

Infant, Newborn, Pregnancy, Female, Humans, Hernias, Diaphragmatic, Congenital, Retrospective Studies, Sildenafil Citrate, Nitric Oxide, Liver, Risk Assessment, Congenital diaphragmatic hernia, liver herniation, prenatal predictors, pulmonary hypertension

Abstract

INTRODUCTION: Congenital diaphragmatic hernia is associated with pulmonary hypoplasia, pulmonary hypertension, and significant neonatal morbidity. Although intrathoracic liver herniation (LH) >20% is associated with adverse outcomes, the relationship between LH

METHODS: A single-center retrospective cohort study was performed from 2011 to 2020 of 80 fetuses with left-sided congenital diaphragmatic hernia that were delivered and repaired at our institution. Perinatal, perioperative, and postoperative data were collected. We evaluated the association of %LH with outcomes as a stratified ordinal variable (0%-10% LH, 10%-19% LH, and >20% LH) and as a continuous variable. Data were analyzed by analysis of variance with Bonferroni post hoc analysis, chi-square analyses, and univariate logistic regression.

RESULTS: Extracorporeal membrane oxygenation (ECMO) (P < 0.001), repair on ECMO (P = 0.002), repair with patch (P < 0.001), length of stay (P = 0.002), inhaled nitric oxide use (P < 0.001), and sildenafil use at discharge (P < 0.001), showed significant differences among LH groups. There were no differences among the groups concerning survival (at discharge, 6 mo, and 1 y) and tracheostomy. On further analysis there was no difference between 10% and 19% LH and ≥20% LH patients concerning ECMO (P = 0.55), repair on ECMO (P = 0.54), repair with patch (P = 1.00), length of stay (P = 1.00), and inhaled nitric oxide use (P = 0.33). Logistic regression analysis displayed a significant association with LH and ECMO, repair on ECMO, repair with patch, inhaled nitric oxide use, and sildenafil use.

CONCLUSIONS: Our analysis displays no significant difference in perinatal management between patients with 10%-19% and ≥20% LH. These findings suggest that the historical cutoff of ≥20% LH may not be sufficient alone to guide perinatal counseling and decision-making.