Anne Pinton1,2, Julia Boubnova3, François Becmeur4, Pierre Kuhn5,6, Marie-Victoire Senat7, Julien Stirnemann8,9, Marianne Capelle3, Jonathan Rosenblatt10, Jérôme Massardier11, Pascal Vaast12, Gwenaelle Le Bouar13, Amélie Desrumaux14, Laure Connant15, Laetitia Begue16, Benoit Parmentier17, Franck Perrotin18, Alain Diguet19, Guillaume Benoist20, Charles Muszynski21, Aurélien Scalabre22, Norbert Winer23,24, Jean-Luc Michel25, Florence Casagrandre-Magne26, Jean-Marie Jouannic27,28, Denis Gallot29, Perrine Coste Mazeau30, Emmanuel Sapin31, Alexis Maatouk32, Anne-Hélène Saliou33, Loïc Sentilhes34, Florence Biquard35, Nicolas Mottet36, Romain Favre37, Alexandra Benachi38, Nicolas Sananès39,40. 1. Department of Obstetrics and Gynecology, Hôpital Trousseau, AP-HP, Paris, France. 2. Sorbonne Université, boulevard de l'Hôpital, Paris, France. 3. Department of Obstetrics and Gynecology, Maternité de la Conception, Gynepole, Marseille, France. 4. Department of Pediatric Surgery, Hôpitaux Universitaires de Strasbourg, Strasbourg, France. 5. Department of Neonatal Intensive Care Unit, Hôpitaux Universitaires de Strasbourg, Strasbourg, France. 6. Institut des Neurosciences Cellulaires et Intégratives, UPR 3212, CNRS et Université de Strasbourg, Strasbourg, France. 7. Department of Obstetrics and Gynecology, Maternal-fetal medicine, Hôpital Bicêtre, AP-HP, Université Paris-Saclay, Le Kremlin-Bicêtre, France. 8. Department of Obstetrics and Gynecology, Maternal-fetal medicine, Hôpital Necker-Enfants malades, AP-HP, Paris, France. 9. EHU7328, Université de Paris and Institut IMAGINE, Paris, France. 10. Department of Obstetrics and Gynecology, Maternal-fetal medicine, Hôpital Universitaire Robert-Debré, AP-HP, Paris, France. 11. Department of Obstetrics and Gynecology, Maternal-fetal medicine, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, University Claude Bernard, Lyon, France. 12. Department of Obstetrics and Gynecology, Centre Hospitalo-Universitaire de Lille, Lille, France. 13. Department of Obstetrics and Gynecology, Centre Hospitalo-Universitaire de Rennes, University of Rennes 1, Rennes, France. 14. Department of Pediatrics, Centre Hospitalo-Universitaire de Grenoble, Grenoble, France. 15. Department of Obstetrics and Gynecology, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France. 16. Department of Obstetrics and Gynecology, Centre Hospitalo-Universitaire de Montpellier, Montpellier, France. 17. Department of Obstetrics and Gynecology, Centre Hospitalo-Universitaire de Poitiers, Poitiers, France. 18. Department of Obstetrics and Gynecology, Centre Hospitalo-Universitaire de Tours, François Rabelais University, Tours, France. 19. Department of Obstetrics and Gynecology, Centre Hospitalo-Universitaire de Rouen, Rouen, France. 20. Department of Obstetrics and Gynecology, Centre Hospitalo-Universitaire de Caen, Normandie University, Caen, France. 21. Department of Obstetrics and Gynecology, Centre Hospitalo-Universitaire d'Amiens, Amiens, France. 22. Department of Pediatric Surgery, Centre Hospitalo-Universitaire de Saint Etienne, Saint-Etienne, France. 23. Department of Obstetrics and Gynecology, Centre Hospitalo-Universitaire de Nantes, Nantes, France. 24. NUN, INRAE, UMR 1280, PhAN, Université de Nantes, CIC Femme enfant adolescent, Nantes, France. 25. Department of Pediatric Surgery, Centre Hospitalo-Universitaire de Félix Guyon, Bellepierre Saint-Denis, Saint-Denis, France. 26. Department of Neonatalogy, Centre Hospitalo-Universitaire de Nice, Nice, France. 27. Department of Obstetrics and Gynecology, Fetal Medicine Department, Hôpital Trousseau AP-HP, Paris, France. 28. Sorbonne université, boulevard de l'Hôpital, Paris, France. 29. Department of Obstetrics and Gynecology, Centre Hospitalo-Universitaire Estaing, Pole FEE, Clermont-Ferrand, France. 30. Department of Obstetrics and Gynecology, Centre Hospitalo-Universitaire de Limoges, Limoges, France. 31. Department of Pediatric Surgery, François-Mitterrand Teaching Hospital, LE2I UMR CNRS 6306, Arts et Métiers, University of Burgundy, Dijon, France. 32. Department of Obstetrics and Gynecology, Centre Hospitalo-Universitaire de Nancy, Nancy, France. 33. Department of Obstetrics and Gynecology, Centre Hospitalo-Universitaire de Brest, Hôpital Morvan, Brest, France. 34. Department of Obstetrics and Gynecology, Centre Hospitalo-Universitaire de Bordeaux, Bordeaux, France. 35. Department of Obstetrics and Gynecology, Centre Hospitalo-Universitaire d'Angers, Angers, France. 36. Department of Obstetrics and Gynecology, Centre Hospitalo-Universitaire de Besançon, Université de Franche-Comté, Besançon, France. 37. Department of Obstetrics and Gynecology, Maternal Fetal Medicine, Hôpitaux universitaires de Strasbourg, Strasbourg, France. 38. Department of Obstetrics and Gynecology and Reproductive Medicine, AP-HP, Antoine Béclère Hospital, University Paris Saclay, Clamart, France. 39. Department of Obstetrics and Gynecology, Hôpitaux universitaires de Strasbourg, Strasbourg, France. 40. INSERM UMR-S 1121 "Biomatériaux et bioingénierie", Université de Strasbourg, Strasbourg, France.
Abstract
OBJECTIVES: The objective of this study was to assess whether the laterality of congenital diaphragmatic hernia (CDH) was a prognostic factor for neonatal survival. METHODS: 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. RESULTS: 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). CONCLUSION: 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.
OBJECTIVES: The objective of this study was to assess whether the laterality of congenital diaphragmatic hernia (CDH) was a prognostic factor for neonatal survival. METHODS: 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. RESULTS: 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). CONCLUSION: Rate of right CDHmortality 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.