Congenital diaphragmatic hernia: A meta-analysis of mortality factors

Purpose: The aim of this study was to review all available studies reported in the English-language literature from 1975 through 1998, and by meta-ana lysis assess the importance of prenatal diagnosis, associated malformations , side of hernia, timing of surgery, and study population on mortality rate s in patients with congenital diaphragmatic hernia (CDH). Methods: One-hundred-two studies were identified, and 51 studies (2,980 pat ients) 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 . Results: Pooled total mortality rate was significantly higher in category I than in category III (75.6% v 58.2%, P < .001). Pooled hidden postnatal mo rtality 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 post natally. Mortality rates were significantly higher among CDH infants with a ssociated major malformations compared with isolated CDH in all 3 categorie s. An increased mortality rate in right-sided CDH was found in category II and III. Conclusions: Prenatal diagnosis of CDH, presence of associated major malfor mations, and the study population have a major influence on mortality rate. The very high mortality rate in studies of fetuses with a prenatal diagnos is of CDH should be taken into account in prenatal counselling. J Pediatr S urg 35:1187-1197. Copyright (C) 2000 by W.B. Saunders Company.