Does the size of the diaphragmatic defect affect the severity of lung hypoplasia and prognosis in congenital diaphragmatic hernia in fetuses and newborns?
DOI:
https://doi.org/10.15574/PS.2025.3(88).1018Keywords:
congenital diaphragmatic hernia, diaphragmatic defect size, impact diaphragmatic defect size, pulmonary hypoplasia, pulmonary hypertension, prognosis, fetus, newbornAbstract
The effect of the size of the diaphragmatic defect on the clinical course of congenital diaphragmatic hernia (CDH) in fetuses and newborns remains insufficiently studied.
Aim - to determine the effect of the size of the diaphragmatic defect on the clinical course of CDH and prognosis in fetuses and newborns.
Materials and methods. Fifty-seven newborns with CDH were examined between 2013 and 2024. The children were divided into two groups according to the size of the diaphragmatic defect: I - small and medium (types A and B) - 38 (66.7%); II - large and total (types C and D) - 19 (33.3%) patients. The degree of lung hypoplasia was assessed using prenatal measurement of the lung-cranial index (LHR), observed/expected lung-cranial index (o/e LHR), and lung-thoracic index (L/T ratio). The presence of hypoplasia of the left heart chambers was diagnosed during the last prenatal ultrasound examination of the fetus before delivery and postnatal echocardiography. The severity of pulmonary hypertension, the presence of right-to-left shunting through open fetal communications, the use of special vasodilators, the duration of preoperative stabilization, and survival were assessed. The area of the diaphragmatic defect was measured intraoperatively.
Results. The average area of the diaphragmatic defect in patients in the group II was significantly larger. In the group II patients, the degree of pulmonary hypoplasia was more pronounced than in the group I. With large and total diaphragmatic defects, pulmonary hypertension was significantly more pronounced than with small and medium defects. No significant difference in the use of special vasodilators was found between the groups. With large and total diaphragmatic defects, there is more frequent pronounced compression of the heart by abdominal organs herniated into the chest cavity, especially parenchymal organs. The average duration of preoperative stabilization of newborns with CDH with large and total diaphragmatic defects is significantly longer. The prognosis for newborns with large and total diaphragmatic defects is worse.
Conclusions. The size of the diaphragmatic defect significantly affects the degree of lung hypoplasia, the severity of pulmonary hypertension, the frequency of hypoplasia of the left heart, the duration of preoperative stabilization, and the survival of newborns, but does not affect the use of special vasodilators. When assessing the prognosis in newborns with CDH and planning their treatment tactics, it is important to take the above factors into account.
The study was conducted in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the local ethics committee of the institution. Informed consent was obtained from patients for the study.
The authors declare no conflict of interest.
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