Department of Obstetrics and Gynecology, Hôpital Trousseau, AP-HP, Paris, France.
Sorbonne Université, boulevard de l'Hôpital, Paris, France.
Prenat Diagn. 2020 Jul;40(8):949-957. doi: 10.1002/pd.5706. Epub 2020 May 8.
The objective of this study was to assess whether the laterality of congenital diaphragmatic hernia (CDH) was a prognostic factor for neonatal survival.
This was a cohort study using the French national database of the Reference Center for Diaphragmatic Hernias. The principal endpoint was survival after hospitalization in intensive care. We made a comparative study between right CDH and left CDH by univariate and multivariate analysis. Terminations and stillbirths were excluded from analyses of neonatal outcomes.
A total of 506 CDH were included with 67 (13%) right CDH and 439 left CDH (87%). Rate of survival was 49% for right CDH and 74% for left CDH (P < .01). Multivariate analysis showed two factors significantly associated with mortality: thoracic herniation of liver (OR 2.27; IC 95% [1.07-4.76]; P = .03) and lung-to-head-ratio over under expected (OR 2.99; IC 95% [1.41-6.36]; P < .01). Side of CDH was not significantly associated with mortality (OR 1.87; IC 95% [0.61-5.51], P = .26).
Rate of right CDH mortality is more important than left CDH. Nevertheless after adjusting for lung-to-head-ratio and thoracic herniation of liver, right CDH does not have a higher risk of mortality than left CDH.
本研究旨在评估先天性膈疝（CDH）的偏侧性是否为新生儿生存的预后因素。
这是一项使用法国膈疝参考中心国家数据库的队列研究。主要终点是重症监护住院后的生存率。我们通过单变量和多变量分析对右侧 CDH 和左侧 CDH 进行了比较研究。排除了终止妊娠和死产的新生儿结局分析。
共纳入 506 例 CDH，其中 67 例（13%）为右侧 CDH，439 例（87%）为左侧 CDH。右侧 CDH 的生存率为 49%，左侧 CDH 的生存率为 74%（P < 0.01）。多变量分析显示，有两个因素与死亡率显著相关：肝脏胸腔疝（OR 2.27；95%CI [1.07-4.76]；P = 0.03）和肺-头比低于预期（OR 2.99；95%CI [1.41-6.36]；P < 0.01）。CDH 的偏侧性与死亡率无显著相关性（OR 1.87；95%CI [0.61-5.51]，P = 0.26）。
右侧 CDH 的死亡率比左侧 CDH 更重要。然而，在调整肺-头比和肝脏胸腔疝后，右侧 CDH 的死亡率并不高于左侧 CDH。
