Article

Congenital diaphragmatic hernia: a meta-analysis of mortality factors.

Department of Surgery, The National Hospital, Oslo, Norway.
Journal of Pediatric Surgery (Impact Factor: 1.31). 08/2000; 35(8):1187-97. DOI: 10.1053/jpsu.2000.8725
Source: PubMed

ABSTRACT The aim of this study was to review all available studies reported in the English-language literature from 1975 through 1998, and by meta-analysis assess the importance of prenatal diagnosis, associated malformations, side of hernia, timing of surgery, and study population on mortality rates in patients with congenital diaphragmatic hernia (CDH).
One-hundred-two studies were identified, and 51 studies (2,980 patients) fulfilled the prespecified inclusion criteria. Studies were grouped according to study population into: (I) fetuses diagnosed prenatally; (II) neonates admitted to a treatment center; and (III) population-based studies.
Pooled total mortality rate was significantly higher in category I than in category III (75.6% v 58.2%, P < .001). Pooled hidden postnatal mortality rate (deaths before admittance to a treatment center) in population-based studies was 34.9%. Prenatally diagnosed patients in both category II and III had significantly higher mortality rates than those diagnosed postnatally. Mortality rates were significantly higher among CDH infants with associated major malformations compared with isolated CDH in all 3 categories. An increased mortality rate in right-sided CDH was found in category II and III.
Prenatal diagnosis of CDH, presence of associated major malformations, and the study population have a major influence on mortality rate. The very high mortality rate in studies of fetuses with a prenatal diagnosis of CDH should be taken into account in prenatal counselling.

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    • "Congenital diaphragmatic hernia (CDH) has an incidence of approximately 1/3,000 live births [Torfs et al., 1992; Skari et al., 2000]. The development of the human diaphragm occurs between the 4th and 12th week of gestation and derives from four components: the septum transversum, the pleuroperitoneal folds, the dorsal mesentery of the esophagus, and the thoracic body wall [Allan and Greer, 1997; Babiuk et al., 2003; Clugston et al., 2006]. "
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    • "These tumors have a uniform immunoreactivity to vimentin, S-100 protein and NSE (neuron-specific enolase), which are very important to confirm diagnosis (Baderca et al., 2008; Frosch, 2007). Diaphragmatic hernia is a protrusion of abdominal viscera into the thoracic cavity through an abnormal opening or defect of diaphragm muscle, being sometimes covered by a membranous sac (Skari et al., 2000; Yoshitomi and Boorman, 1991). It can occur due to defects in the diaphragm muscle present at birth date (congenital hernia) or as a consequence of trauma (acquired hernia) (Tenbrinck et al., 1990). "
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