Prognostic value of a hernia sac in congenital diaphragmatic hernia

Objective To investigate the prognostic value of a hernia sac in isolated congenital diaphragmatic hernia ( CDH ). Methods Our database was searched to identify all consecutive cases of CDH referred to our fetal medicine unit between January 2004 and August 2011. Presence or absence of a hernia sac was assessed in liveborn cases using surgery or postnatal autopsy reports. We studied the correlation between the presence of a hernia sac and prenatal findings and perinatal morbidity and mortality. Results Over the study period, there were 70 cases with isolated CDH born alive in which either a surgery or autopsy report was available. Neonatal death, either preoperative or postoperative, occurred in 1/18 (5.6%) infants with a hernia sac and in 17/52 (32.7%) cases without a hernia sac( P  = 0.03). Patients with a hernia sac had a significantly higher observed to expected pulmonary volume on prenatal magnetic resonance imaging (51.9 vs 39.3%, P  = 0.01). Neonatal morbidity in surviving infants was lower in the group with a hernia sac, although not significantly. Conclusion The presence of a hernia sac is associated with a higher pulmonary volume and a better overall prognosis for CDH . Copyright © 2012 ISUOG. Published by John Wiley & Sons, Ltd.