Prenatal stomach position and volume in relation to postnatal outcomes in left‐sided congenital diaphragmatic hernia. (28th July 2021)

• Record Type: Journal Article
• Authors: Weller, Katinka; Peters, Nina C. J.; van Rosmalen, Joost; Cochius‐Den Otter, Suzan C. M.; DeKoninck, Philip L. J.; Wijnen, Rene M. H.; Cohen‐Overbeek, Titia E.; Eggink, Alex J.
• Is Part Of: Prenatal diagnosis. Volume 42:Number 3(2022)
• Page Start: 338
• Page End: 347
• Publication Date: 2021-07-28
• Subjects: Prenatal diagnosis -- Periodicals; Fetus -- Diseases -- Diagnosis -- Periodicals; Electronic journals; 618.32075
• DOI: 10.1002/pd.6019
• Languages: English
• ISSNs: 0197-3851

Abstract

Abstract: Objective: To examine the association between prenatal stomach position (SP) grade and stomach volume (SV) and the need for pulmonary hypertension (PH) treatment after birth in prenatally diagnosed left‐sided congenital diaphragmatic hernia (CDH), live born >34 weeks. Methods: In retrospect, SP grade and SV were determined in fetuses with isolated left‐sided CDH from 19 weeks gestational age (GA) onwards at three different time periods (≤24 weeks' GA: US1, 24–30 weeks' GA: US2; ≥30 weeks' GA: US3). Primary outcome was need for treatment of PH after birth. Secondary analyses included the predictive value of SP and SV for other respiratory outcomes and postnatal defect size. Results: A total of 101 fetuses were included. SP grade was significantly associated with need for treatment of PH (US1, US2, and US3: p < 0.02). Also, prenatal SP grade was positively associated with defect size and development of chronic lung disease (CLD) in survivors. No association was found between SV and respiratory morbidities or postnatal defect size. Conclusion: SP grade in left‐sided CDH fetuses is associated with an increased need for PH treatment, a larger postnatal defect size and CLD in survivors. We consider SP determination a valuable contribution to the prenatal assessment of left‐sided CDH. Key points: What is already known about this topic? Prenatal stomach position (SP) grade has been proposed as a predictive ultrasound parameter for postnatal survival, patch repair, need for extracorporeal membrane oxygenation and need for prolonged respiratory support in left‐sided congenital diaphragmatic hernia (CDH). What does this study add? In children with left‐sided CDH, prenatal SP grade is associated with an increase in need for treatment of pulmonary hypertension and development of chronic lung disease, with the greatest increase in SP Grade 2 and 4. A higher prenatal SP grade is associated with a larger postnatal defect size. In the majority of cases SP grade does not vary throughout gestation.