- If the LHR is greater than 1.4, the prognosis is better
More recently, MRI and three dimensional ultrasound has been used to calculate
three dimensional volumes in fetal CDH.
Liver position (intrathoracic vs intraabdominal has also been described as a measure
of severity. Polyhydramnios has been variably predictable of poor outcome.
Delivery room management: Adequate oxygenation and ventilation must be
established quickly and efficiently while preventing large volumes of air from entering
the stomach & bowel. Bag and mask resuscitation must be avoided unless in
respiratory distress; and therefore prompt intubation is indicated. Placement of OG tube
to decompress the bowel needs to be done during the resuscitation period.
NICU Management of CDH
Placement of umbilical arterial and venous lines for continuous BP monitoring
and access for possible vasopressor therapy
Urine output should be closely monitored as an index of organ perfusion
Adequate sedation; paralysis if necessary Echocardiogram: R/O congenital heart disease, assess for ventricular function
and PPHN; also a pre-ECMO evaluation
Head U/S: R/O intracranial hemorrhage is a “pre-ECMO” criteria