The grading of stomach position for postnatal outcomes in isolated left‐sided congenital diaphragmatic hernia: A systematic review and meta‐analysis

Abstract

AbstractObjectivesTo evaluate the correlation between stomach position (SP) grading and postnatal outcomes in fetuses with isolated left‐sided congenital diaphragmatic hernias (CDHs).MethodsA literature search was conducted using the PubMed, Embase, and Cochrane Library databases. The corresponding 95% confidence intervals (CIs) were used to assess the differences in the odds of mortality according to the SP graded as level 0 to level 3. To evaluate the reliability of our results, a sensitivity analysis was also conducted.ResultsNine papers with a total of 542 fetuses with isolated left‐sided CDH were included. Congenital diaphragmatic hernia pregnancies complicated by an intrathoracic stomach had higher odds of neonatal mortality when compared with intraabdominal stomach (odds ratio [OR] 2.86; 95% CI 1.38–5.94). Four papers with SP grading from level 0 to level 3 were included in a subgroup analysis. Stomach position at level 1 and level 2 had lower odds of neonatal mortality when separately compared to level 3 (OR 0.12; 95% CI 0.04–0.33) and (OR 0.30; 95% CI 0.16–0.54). Stomach position at level 1 had lower odds of neonatal mortality when compared with level 2 + 3 (OR 0.25; 95% CI 0.09–0.66).ConclusionSurvival of fetuses with isolated left‐sided CDH is correlated with the SP.