The following is a summary of “Postnatal Imaging for Prediction of Outcome in Patients with Left-sided Congenital Diaphragmatic Hernia,” published in the December 2022 issue of Pediatrics by Kim, et al.


For a study, researchers sought to examine relationships between postnatal imaging characteristics and the fate of a left-sided congenital diaphragmatic hernia, as measured by overall survival and the need for extracorporeal membrane oxygenation (ECMO).

Between January 2013 and September 2021, prenatal diagnoses of left-sided congenital diaphragmatic hernia were examined. The esophageal deviation index was recently introduced as the biggest diameter from the midline to the deviated stomach tube divided by the largest transverse diameter of the thoracic cavity on the radiograph. They used regression models to find postnatal imaging characteristics linked to overall survival and the need for ECMO. Prenatal, postnatal, and intraoperative results’ predictive ability to predict survival was measured (i.e., the area under the curve [AUC] of a time-dependent receiver operating characteristic curve).

The analysis involved 97 individuals (54 men; average gestational age of 38.3±1.9 weeks; the average birth weight of 2956.5±540.0 g). The esophageal deviation index and right pneumothorax (adjusted HR, 8.763; P=.002) were related to overall survival and the need for ECMO, respectively (adjusted hazard ratio [HR], moderate [≥0.19 to <0.24], 6.427 [P = .029]; severe [≥0.24], 33.007 [P<.001]). On postnatal ultrasonography, liver herniation was similarly related to overall survival (P<.001) and the requirement for ECMO (P =.001). Additionally, the accuracy of the AUC for predicting 1-year survival from postnatal ultrasonography was equivalent to that of liver herniation diagnosed during pregnancy or surgery (0.93; 95% CI, 0.88-0.97).

Patients with a left-sided congenital diaphragmatic hernia may benefit from the prognostic information provided by the esophageal deviation index, a right pneumothorax, and a liver herniation shown on postnatal imaging.

Reference: jpeds.com/article/S0022-3476(22)00701-6/fulltext