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Am J Perinatol 2019; 36(12): 1304-1309
DOI: 10.1055/s-0038-1676830
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Outcomes of Congenital Diaphragmatic Hernia in One of the Twins

Weipeng Wang   *
1   Department of Pediatric Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
,
Weihua Pan   *
1   Department of Pediatric Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
,
Jie Chen
1   Department of Pediatric Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
,
Wei Xie
2   Department of Pediatric Surgery Intensive Care Unit, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
,
Ming Liu
3   Department of Radiology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
,
Jun Wang
1   Department of Pediatric Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
› Author Affiliations Funding This study was funded by Shanghai Jiao Tong University School of Medicine (grant numbers JQ201708). We would like to thank Shourong Huang for collecting the data.
Further Information

Publication History

15 August 2018

16 November 2018

Publication Date:
04 January 2019 (online)

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Abstract

Objective Congenital diaphragmatic hernia (CDH) occurred in one of the twins is rarely seen. This study aims to describe the clinical features and outcomes of this special CDH.

Study Design The medical records of all CDH neonates treated in our institution between 2010 and 2016 were retrospectively reviewed. Data were analyzed using parametric and nonparametric tests, appropriately. Association between the twin pregnancy and outcomes was assessed.

Results Eighty-nine patients met the inclusion criteria. In the multivariate analysis, liver herniation, observed/expected lung-to-head circumference ratio, and lower birth weight were independently related to the survival rate of CDH. Eleven patients were identified with CDH occurred in only one of the twins. Among them, seven patients (63.6%) were premature and six (54.5%) were found with low birth weight. Compared with CDH patients with singleton pregnancy, they had significantly higher rates of prematurity (p < 0.001) and lower birth weight (p < 0.001). Additionally, they had worse outcomes with a shorter duration of mechanical ventilation (p = 0.015) and lower survival rate at discharge (p = 0.024).

Conclusion Preterm birth and low birth weight are more common in CDH patients with twin pregnancy, which may lead to worse outcomes.

Keywords

congenital diaphragmatic hernia - twins - preterm birth - low birth weight - outcome
 

  • References

  • 1 Wynn J, Yu L, Chung WK. Genetic causes of congenital diaphragmatic hernia. Semin Fetal Neonatal Med 2014; 19 (06) 324-330
    CrossrefPubMedSearch in Google Scholar
  • 2 Ohno M, Kanamori Y, Sato K. , et al. Congenital diaphragmatic hernia in dizygotic twins. J Ped Surg Case Reports 2015; 3 (03) 114-116
    PubMedSearch in Google Scholar
  • 3 Pober BR, Lin A, Russell M. , et al. Infants with Bochdalek diaphragmatic hernia: sibling precurrence and monozygotic twin discordance in a hospital-based malformation surveillance program. Am J Med Genet A 2005; 138A (02) 81-88
    CrossrefPubMedSearch in Google Scholar
  • 4 Veenma D, Brosens E, de Jong E. , et al. Copy number detection in discordant monozygotic twins of congenital diaphragmatic hernia (CDH) and esophageal atresia (EA) cohorts. Eur J Hum Genet 2012; 20 (03) 298-304
    PubMedSearch in Google Scholar
  • 5 McGivern MR, Best KE, Rankin J. , et al. Epidemiology of congenital diaphragmatic hernia in Europe: a register-based study. Arch Dis Child Fetal Neonatal Ed 2015; 100 (02) F137-F144
    CrossrefPubMedSearch in Google Scholar
  • 6 Moini A, Shiva M, Arabipoor A, Hosseini R, Chehrazi M, Sadeghi M. Obstetric and neonatal outcomes of twin pregnancies conceived by assisted reproductive technology compared with twin pregnancies conceived spontaneously: a prospective follow-up study. Eur J Obstet Gynecol Reprod Biol 2012; 165 (01) 29-32
    CrossrefPubMedSearch in Google Scholar
  • 7 Jani JC, Peralta CF, Nicolaides KH. Lung-to-head ratio: a need to unify the technique. Ultrasound Obstet Gynecol 2012; 39 (01) 2-6
    CrossrefPubMedSearch in Google Scholar
  • 8 Lally KP, Lasky RE, Lally PA. , et al; Congenital Diaphragmatic Hernia Study Group. Standardized reporting for congenital diaphragmatic hernia--an international consensus. J Pediatr Surg 2013; 48 (12) 2408-2415
    CrossrefPubMedSearch in Google Scholar
  • 9 Morini F, Valfrè L, Capolupo I, Lally KP, Lally PA, Bagolan P. ; Congenital Diaphragmatic Hernia Study Group. Congenital diaphragmatic hernia: defect size correlates with developmental defect. J Pediatr Surg 2013; 48 (06) 1177-1182
    CrossrefPubMedSearch in Google Scholar
  • 10 Zhang R, Thiele H, Bartmann P. , et al. Whole-exome sequencing in nine monozygotic discordant twins. Twin Res Hum Genet 2016; 19 (01) 60-65
    CrossrefPubMedSearch in Google Scholar
  • 11 Bricker L. Optimal antenatal care for twin and triplet pregnancy: the evidence base. Best Pract Res Clin Obstet Gynaecol 2014; 28 (02) 305-317
    CrossrefPubMedSearch in Google Scholar
  • 12 Gentili A, Pasini L, Iannella E. , et al. Predictive outcome indexes in neonatal congenital diaphragmatic hernia. J Matern Fetal Neonatal Med 2015; 28 (13) 1602-1607
    CrossrefPubMedSearch in Google Scholar
  • 13 Grover TR, Murthy K, Brozanski B. , et al; Children's Hospitals Neonatal Consortium. Short-term outcomes and medical and surgical interventions in infants with congenital diaphragmatic hernia. Am J Perinatol 2015; 32 (11) 1038-1044
    Thieme ConnectPubMedSearch in Google Scholar
  • 14 Frey HA, Klebanoff MA. The epidemiology, etiology, and costs of preterm birth. Semin Fetal Neonatal Med 2016; 21 (02) 68-73
    CrossrefPubMedSearch in Google Scholar
  • 15 Brindle ME, Cook EF, Tibboel D, Lally PA, Lally KP. ; Congenital Diaphragmatic Hernia Study Group. A clinical prediction rule for the severity of congenital diaphragmatic hernias in newborns. Pediatrics 2014; 134 (02) e413-e419
    CrossrefPubMedSearch in Google Scholar
  • 16 Kadir D, Lilja HE. Risk factors for postoperative mortality in congenital diaphragmatic hernia: a single-centre observational study. Pediatr Surg Int 2017; 33 (03) 317-323
    CrossrefPubMedSearch in Google Scholar
  • 17 Salas AA, Bhat R, Dabrowska K. , et al. The value of Pa(CO2) in relation to outcome in congenital diaphragmatic hernia. Am J Perinatol 2014; 31 (11) 939-946
    Thieme ConnectPubMedSearch in Google Scholar