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The presence of a hernia sac in congenital diaphragmatic hernia is associated with better fetal lung growth and outcomes.

AbstractPURPOSE:
The purpose of this study was to evaluate the relationship between the presence of a hernia sac and fetal lung growth and outcomes in infants with Congenital, Diaphragmatic Hernia (CDH).
METHODS:
The medical records of all neonates with CDH treated in our institution between 2004 and 2011 were reviewed. The presence of a hernia sac was confirmed at the time of surgical repair or at autopsy. Data were analyzed using parametric and non-parametric tests where appropriate. Multivariable regression and survival analyses were applied.
RESULTS:
Of 148 neonates treated for CDH, 107 (72%) had isolated CDH and 30 (20%) had a hernia sac. Infants with a hernia sac had significantly lower need for ECMO, patch repair, supplemental oxygen at 30 days of life, and shorter duration of mechanical ventilation and hospital stay. Ninety-three patients had prenatal imaging. The mean observed-to-expected total fetal lung volume in the sac group was higher throughout gestation. Although a greater percentage of sac patients had liver herniation as a dichotomous variable, the amount of herniated liver (%LH and LiTR) was significantly lower in the presence of a hernia sac.
CONCLUSION:
The presence of a hernia sac in Congenital Diaphragmatic Hernia is associated with less visceral herniation, greater fetal lung growth, and better post-natal outcomes.
AuthorsIrving J Zamora, Darrell L Cass, Timothy C Lee, Stephen Welty, Christopher I Cassady, Amy R Mehollin-Ray, Sara C Fallon, Rodrigo Ruano, Michael A Belfort, Oluyinka O Olutoye
JournalJournal of pediatric surgery (J Pediatr Surg) Vol. 48 Issue 6 Pg. 1165-71 (Jun 2013) ISSN: 1531-5037 [Electronic] United States
PMID23845602 (Publication Type: Evaluation Study, Journal Article)
CopyrightCopyright © 2013 Elsevier Inc. All rights reserved.
Topics
  • Cohort Studies
  • Combined Modality Therapy
  • Extracorporeal Membrane Oxygenation
  • Female
  • Fetal Organ Maturity
  • Hernia, Diaphragmatic (embryology, mortality, pathology, therapy)
  • Hernias, Diaphragmatic, Congenital
  • Herniorrhaphy
  • Humans
  • Infant, Newborn
  • Length of Stay (statistics & numerical data)
  • Linear Models
  • Logistic Models
  • Lung (embryology)
  • Male
  • Multivariate Analysis
  • Pregnancy
  • Prenatal Diagnosis
  • Retrospective Studies
  • Survival Analysis
  • Treatment Outcome

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