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

ObjectivesTo 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.