287 - Risk Factors for Chronic Lung Diseases in Fetuses Diagnosed with Isolated Left-sided Congenital Diaphragmatic Hernia

Congenital diaphragmatic hernia (CDH) is a rare disease with congenital defect of diaphragm, which causes lung hypoplasia and is associated with high mortality. Survival rates have increased with improvements including gentle ventilation strategies and extracorporeal membrane oxygenation (ECMO) in selected cases. Survivors of CDH have a substantial risk of short-term pulmonary morbidity that impedes timely discharge and bonding with caregivers.

Objective: The aim of this study is to address the incidence and the perinatal risk factors for chronic lung disease (CLD) in isolated left-CDH.

Design/Methods:

We retrospectively reviewed the medical records of newborn infants who were prenatally diagnosed as isolated left CDH and were born ≥ 34 weeks of gestation. CLD was defined as oxygen or respiratory support dependency at 30 days of life. Serious respiratory morbidities were defined as the occurrence of at least one of the following: tracheostomy, continued hospitalization for respiratory reasons ≥ PMA 50 weeks, use of supplemental oxygen or respiratory support, and two or more rehospitalization for respiratory reasons. We compared the perinatal characteristics including the fetal lung volume, measured as the observed-to-expected lung-to-head ratio (O/E LHR), anthropometric measure, and treatment factors between the CLD group and the non-CLD group in survivors.

Results:

A total of 103 survivors of isolated left CDH were included. The median gestational age was 38+5 weeks (range 34+1-40+3 weeks), and the median birth weight was 3050 g (range 1420-4240 g). Thirty-six (35.0%) patients were diagnosed as CLD including 14 (13.6%) patients under mechanical ventilator. The O/E LHR values were significantly lower in the CLD group (46.4 ± 12.3) than in the non-CLD group (61.4 ± 14.3, P< 0.001). The incidence of liver (47% vs. 9%, P< 0.001) and stomach (89% vs. 57%, P=0.001) herniation was also significantly higher in the CLD group versus the non-CLD group. In the univariate analysis, cesarean section, small for gestational age, lower 5-minutes APGAR score were risk factors of CLD. As expected, the CLD group had a greater burden of supportive management including longer duration of mechanical ventilation and higher incidence of high frequency oscillation ventilator, inotropes, inhaled nitric oxide, and ECMO (P< 0.001, respectively). In multivariate analyses, prenatal liver herniation, lower O/E LHR, and intrauterine growth restriction (IUGR) were associated with an increased risk of CLD.

Conclusion(s):

In addition to the parameters that predict lung hypoplasia, IUGR was associated with short-term respiratory morbidity.