Comparison of current to past outcomes in congenital diaphragmatic hernia using MRI observed-to-expected total fetal lung volume

Background Fetal Centers use imaging studies to predict congenital diaphragmatic hernia (CDH) prognosis and the need for fetal therapy. Given improving CDH survival, we hypothesized that current fetal imaging severity predictions no longer reflect true outcomes and fail to justify the risks of fetal therapy. Methods We analyzed our single-center contemporary data in a left-sided CDH cohort ( n = 58) by prognostic criteria determined by MRI observed-to-expected total fetal lung volumes: severe 35%. We compared contemporary survival to prior studies and the TOTAL trials. Results Contemporary survival was significantly higher than past studies for all prognostic classifications (mild 100% vs 80–94%, moderate 95% vs 59–75%, severe 79% vs 13–25%; P