Antenatal diagnosis of isolated congenital diaphragmatic hernia is not an indicator of outcome

It has been reported previously that infants diagnosed with congenital diaphragmatic hernia (CDH) antenatally have a much poorer prognosis than those diagnosed postnatally. The authors identified 173 high-risk (symptomatic within the first 6 hours of life) infants with CDH treated in the past decade. Seventy-seven cases were diagnosed antenatally and 96 were diagnosed postnatally. The survival rate was slightly worse for the antenatal group (34% v 48% for the postnatal group; P = .04). However, 59 of the 173 patients (34%) had other life-threatening congenital anomalies. Among the 114 patients with isolated CDH, the survival rate increased to 59% in the antenatal group and 63% in the postnatal group—a difference that was not significant. The timing of antenatal diagnosis (> or 25 weeks), is of no value in predicting outcome; (2) survival for patients with antenatally diagnosed isolated CDH is much higher than previously reported, a fact that should be considered when antenatal manipulations such as in utero CDH repair or termination of pregnancy are contemplated; (3) awareness of CDH by antenatal diagnosis leads to more effective resuscitation after birth; and (4) CDH associated with another significant anomaly, especially cardiac, currently has a dismal prognosis, irrespective of timing of diagnosis.