Small prenatal diameter of the ascending aorta is associated with increased mortality risk in neonates with congenital diaphragmatic hernia

Abstract

Introduction The aim of this study was to evaluate if selected prenatal markers obtainded from fetal echocardiography can predict postnatal outcome in congenital diaphragmatic hernia (CDH) patients. We also aimed to verify the prognostic value of lung-to-head ratio (LHR). Material and methods The study group included 29 fetuses with CDH. We analyzed potentially prognostic parameters measured using fetal echocardiography and fetal ultrasound. The assessed parameters were compared between the group of patients with CDH who survived to discharge (n=21) and the subset of patients who died before discharge from hospital (n=8). Results In survivors, mean z-score for ascending aorta (AAo) diameter was 0.23 ± 0.98 vs – 1.82 ± 1.04 in patients who died (t-test, p=0.0015). In survivors, the main pulmonary artery/ascending aorta ratio was 1.22 ± 0.17 vs 1.46 ± 0.21 in patients who died (t-test, p=0.017). In survivors, the LHR was 1.81 ± 0.96 vs 0.95 ± 0.6 in patients who died (t-test, p=0.019). In survivors, the observed to expected LHR was 57% ± 30% vs 30% ± 18% in patients who died (t-test, p=0.018). Conclusions Narrowing of the ascending aorta in CDH fetuses is a poor prognostic factor associated with increased mortality in neonates. Our study also confirmed the prognostic value of LHR.

Keywords

• risk factor
• ultrasound
• prenatal diagnosis
• fetus
• fetal echocardiography
• congenital diaphragmatic hernia
• aorta
• fetal heart