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Furman Y, Gavri-Beker A, Miller TE, Bilik R, Rosenblat O, Avnet H, Lipitz S, Yinon Y, Strauss T, Weisz B. Do Serial Sonographic Assessments of Fetuses with Isolated Congenital Diaphragmatic Hernia Help Us Predict Survival? Fetal Diagn Ther 2021; 48:421-429. [PMID: 34247165 DOI: 10.1159/000515693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 03/05/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim of this study was to assess the ability of serial prenatal sonographic measurements, and specifically changes in the observed-to-expected lung-to-head ratio (O/E LHR) throughout gestation and to predict survival in congenital diaphragmatic hernia (CDH). METHODS Retrospective study of CDH fetuses evaluated prenatally and treated postnatally in a single tertiary center, 2008-2020. Sonographic evaluations included side of herniation, liver involvement, and O/E LHR. All data were calculated to assess ability to predict survival. RESULTS Overall, 94 fetuses were evaluated prenatally and delivered in our medical center. Among them, 75 had isolated CDH and 19 nonisolated. CDH was categorized as left (n = 76; 80.8%), right (n = 16; 17.0%), or bilateral (n = 2; 2.2%). Overall perinatal survival rate was 57% for all live-born infants, 68% in isolated CDH, and 40% in nonisolated (excluding 2 cases that underwent fetoscopic endoluminal tracheal occlusion and did not survive). The O/E LHR was lower in cases with perinatal death compared to survivors. In cases with multiple evaluations, the minimal O/E LHR was the most accurate predictor of survival and need for perinatal extracorporeal membrane oxygenation (ECMO) support. This remained significant when excluding twin pregnancies or when evaluating only isolated left CDH. In addition to disease severity, the side of herniation and liver position was associated with preoperative mortality. CONCLUSION O/E LHR is associated with perinatal survival. In cases with multiple evaluations, the minimal O/E LHR is the most accurate and significant predictor of perinatal mortality and need for ECMO support.
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Affiliation(s)
- Yael Furman
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ayelet Gavri-Beker
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Neonatology, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Tal Elkan Miller
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Institute of Obstetrical and Gynecological Imaging, Fetal Medicine Unit, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Ron Bilik
- Department of Pediatric Surgery, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Orgad Rosenblat
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Institute of Obstetrical and Gynecological Imaging, Fetal Medicine Unit, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Hagay Avnet
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Institute of Obstetrical and Gynecological Imaging, Fetal Medicine Unit, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Shlomo Lipitz
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Institute of Obstetrical and Gynecological Imaging, Fetal Medicine Unit, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Yoav Yinon
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Institute of Obstetrical and Gynecological Imaging, Fetal Medicine Unit, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Tzipora Strauss
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Neonatology, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Boaz Weisz
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Institute of Obstetrical and Gynecological Imaging, Fetal Medicine Unit, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
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Schopper MA, Walkup LL, Tkach JA, Higano NS, Lim FY, Haberman B, Woods JC, Kingma PS. Evaluation of Neonatal Lung Volume Growth by Pulmonary Magnetic Resonance Imaging in Patients with Congenital Diaphragmatic Hernia. J Pediatr 2017; 188:96-102.e1. [PMID: 28669608 DOI: 10.1016/j.jpeds.2017.06.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 04/25/2017] [Accepted: 06/01/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate postnatal lung volume in infants with congenital diaphragmatic hernia (CDH) and determine if a compensatory increase in lung volume occurs during the postnatal period. STUDY DESIGN Using a novel pulmonary magnetic resonance imaging method for imaging neonatal lungs, the postnatal lung volumes in infants with CDH were determined and compared with prenatal lung volumes obtained via late gestation magnetic resonance imaging. RESULTS Infants with left-sided CDH (2 mild, 9 moderate, and 1 severe) were evaluated. The total lung volume increased in all infants, with the contralateral lung increasing faster than the ipsilateral lung (mean ± SD: 4.9 ± 3.0 mL/week vs 3.4 ± 2.1 mL/week, P = .005). In contrast to prenatal studies, the volume of lungs of infants with more severe CDH grew faster than the lungs of infants with more mild CDH (Spearman's ρ=-0.086, P = .01). Although the contralateral lung volume grew faster in both mild and moderate groups, the majority of total lung volume growth in moderate CDH came from increased volume of the ipsilateral lung (42% of total lung volume increase in the moderate group vs 32% of total lung volume increase in the mild group, P = .09). Analysis of multiple clinical variables suggests that increased weight gain was associated with increased compensatory ipsilateral lung volume growth (ρ = 0.57, P = .05). CONCLUSIONS These results suggest a potential for postnatal catch-up growth in infants with pulmonary hypoplasia and suggest that weight gain may increase the volume growth of the more severely affected lung.
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Affiliation(s)
- Melissa A Schopper
- Section of Neonatology, Perinatal and Pulmonary Biology, The Perinatal Institute, Cincinnati, OH
| | - Laura L Walkup
- Division of Pulmonary Medicine, Department of Radiology, Center for Pulmonary Imaging Research, Cincinnati, OH
| | - Jean A Tkach
- Department of Radiology, Imaging Research Center, Austin, TX
| | - Nara S Higano
- Division of Pulmonary Medicine, Department of Radiology, Center for Pulmonary Imaging Research, Cincinnati, OH; Deparment of Physics, Washington University in St. Louis, St. Louis, MO
| | - Foong Yen Lim
- Cincinnati Fetal Center, Cincinnati, OH; Divisions of Pediatric General, Thoracic and Fetal Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Beth Haberman
- Section of Neonatology, Perinatal and Pulmonary Biology, The Perinatal Institute, Cincinnati, OH
| | - Jason C Woods
- Division of Pulmonary Medicine, Department of Radiology, Center for Pulmonary Imaging Research, Cincinnati, OH; Deparment of Physics, Washington University in St. Louis, St. Louis, MO
| | - Paul S Kingma
- Section of Neonatology, Perinatal and Pulmonary Biology, The Perinatal Institute, Cincinnati, OH; Cincinnati Fetal Center, Cincinnati, OH.
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Britto ISW, Sananes N, Olutoye OO, Cass DL, Sangi-Haghpeykar H, Lee TC, Cassady CI, Mehollin-Ray A, Welty S, Fernandes C, Belfort MA, Lee W, Ruano R. Standardization of Sonographic Lung-to-Head Ratio Measurements in Isolated Congenital Diaphragmatic Hernia: Impact on the Reproducibility and Efficacy to Predict Outcomes. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2015; 34:1721-1727. [PMID: 26307118 DOI: 10.7863/ultra.15.14.11064] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 12/16/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVES The purpose of this study was to evaluate the impact of standardization of the lung-to-head ratio measurements in isolated congenital diaphragmatic hernia on prediction of neonatal outcomes and reproducibility. METHODS We conducted a retrospective cohort study of 77 cases of isolated congenital diaphragmatic hernia managed in a single center between 2004 and 2012. We compared lung-to-head ratio measurements that were performed prospectively in our institution without standardization to standardized measurements performed according to a defined protocol. RESULTS The standardized lung-to-head ratio measurements were statistically more accurate than the nonstandardized measurements for predicting neonatal mortality (area under the receiver operating characteristic curve, 0.85 versus 0.732; P = .003). After standardization, there were no statistical differences in accuracy between measurements regardless of whether we considered observed-to-expected values (P > .05). Standardization of the lung-to-head ratio did not improve prediction of the need for extracorporeal membrane oxygenation (P> .05). Both intraoperator and interoperator reproducibility were good for the standardized lung-to-head ratio (intraclass correlation coefficient, 0.98 [95% confidence interval, 0.97-0.99]; bias, 0.02 [limits of agreement, -0.11 to +0.15], respectively). CONCLUSIONS Standardization of lung-to-head ratio measurements improves prediction of neonatal outcomes. Further studies are needed to confirm these results and to assess the utility of standardization of other prognostic parameters.
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Affiliation(s)
- Ingrid Schwach Werneck Britto
- Texas Children's Fetal Center, Houston, Texas USA (I.S.W.B., N.S., O.O.O., D.L.C., T.C.L., C.I.C., A.M.-R., S.W., C.F., M.A.B., W.L., R.R.); and Department of Obstetrics and Gynecology (I.S.W.B., N.S., H.S.-H., M.A.B., W.L., R.R.), Michael E. DeBakey Department of Surgery (O.O.O., D.L.C., T.C.L.), Department of Radiology (C.I.C., A.M.-R.), and Department of Pediatrics, Section of Neonatology (S.W., C.F.), Baylor College of Medicine, Houston, Texas USA
| | - Nicolas Sananes
- Texas Children's Fetal Center, Houston, Texas USA (I.S.W.B., N.S., O.O.O., D.L.C., T.C.L., C.I.C., A.M.-R., S.W., C.F., M.A.B., W.L., R.R.); and Department of Obstetrics and Gynecology (I.S.W.B., N.S., H.S.-H., M.A.B., W.L., R.R.), Michael E. DeBakey Department of Surgery (O.O.O., D.L.C., T.C.L.), Department of Radiology (C.I.C., A.M.-R.), and Department of Pediatrics, Section of Neonatology (S.W., C.F.), Baylor College of Medicine, Houston, Texas USA
| | - Oluyinka O Olutoye
- Texas Children's Fetal Center, Houston, Texas USA (I.S.W.B., N.S., O.O.O., D.L.C., T.C.L., C.I.C., A.M.-R., S.W., C.F., M.A.B., W.L., R.R.); and Department of Obstetrics and Gynecology (I.S.W.B., N.S., H.S.-H., M.A.B., W.L., R.R.), Michael E. DeBakey Department of Surgery (O.O.O., D.L.C., T.C.L.), Department of Radiology (C.I.C., A.M.-R.), and Department of Pediatrics, Section of Neonatology (S.W., C.F.), Baylor College of Medicine, Houston, Texas USA
| | - Darrell L Cass
- Texas Children's Fetal Center, Houston, Texas USA (I.S.W.B., N.S., O.O.O., D.L.C., T.C.L., C.I.C., A.M.-R., S.W., C.F., M.A.B., W.L., R.R.); and Department of Obstetrics and Gynecology (I.S.W.B., N.S., H.S.-H., M.A.B., W.L., R.R.), Michael E. DeBakey Department of Surgery (O.O.O., D.L.C., T.C.L.), Department of Radiology (C.I.C., A.M.-R.), and Department of Pediatrics, Section of Neonatology (S.W., C.F.), Baylor College of Medicine, Houston, Texas USA
| | - Haleh Sangi-Haghpeykar
- Texas Children's Fetal Center, Houston, Texas USA (I.S.W.B., N.S., O.O.O., D.L.C., T.C.L., C.I.C., A.M.-R., S.W., C.F., M.A.B., W.L., R.R.); and Department of Obstetrics and Gynecology (I.S.W.B., N.S., H.S.-H., M.A.B., W.L., R.R.), Michael E. DeBakey Department of Surgery (O.O.O., D.L.C., T.C.L.), Department of Radiology (C.I.C., A.M.-R.), and Department of Pediatrics, Section of Neonatology (S.W., C.F.), Baylor College of Medicine, Houston, Texas USA
| | - Timothy C Lee
- Texas Children's Fetal Center, Houston, Texas USA (I.S.W.B., N.S., O.O.O., D.L.C., T.C.L., C.I.C., A.M.-R., S.W., C.F., M.A.B., W.L., R.R.); and Department of Obstetrics and Gynecology (I.S.W.B., N.S., H.S.-H., M.A.B., W.L., R.R.), Michael E. DeBakey Department of Surgery (O.O.O., D.L.C., T.C.L.), Department of Radiology (C.I.C., A.M.-R.), and Department of Pediatrics, Section of Neonatology (S.W., C.F.), Baylor College of Medicine, Houston, Texas USA
| | - Christopher I Cassady
- Texas Children's Fetal Center, Houston, Texas USA (I.S.W.B., N.S., O.O.O., D.L.C., T.C.L., C.I.C., A.M.-R., S.W., C.F., M.A.B., W.L., R.R.); and Department of Obstetrics and Gynecology (I.S.W.B., N.S., H.S.-H., M.A.B., W.L., R.R.), Michael E. DeBakey Department of Surgery (O.O.O., D.L.C., T.C.L.), Department of Radiology (C.I.C., A.M.-R.), and Department of Pediatrics, Section of Neonatology (S.W., C.F.), Baylor College of Medicine, Houston, Texas USA
| | - Amy Mehollin-Ray
- Texas Children's Fetal Center, Houston, Texas USA (I.S.W.B., N.S., O.O.O., D.L.C., T.C.L., C.I.C., A.M.-R., S.W., C.F., M.A.B., W.L., R.R.); and Department of Obstetrics and Gynecology (I.S.W.B., N.S., H.S.-H., M.A.B., W.L., R.R.), Michael E. DeBakey Department of Surgery (O.O.O., D.L.C., T.C.L.), Department of Radiology (C.I.C., A.M.-R.), and Department of Pediatrics, Section of Neonatology (S.W., C.F.), Baylor College of Medicine, Houston, Texas USA
| | - Stephen Welty
- Texas Children's Fetal Center, Houston, Texas USA (I.S.W.B., N.S., O.O.O., D.L.C., T.C.L., C.I.C., A.M.-R., S.W., C.F., M.A.B., W.L., R.R.); and Department of Obstetrics and Gynecology (I.S.W.B., N.S., H.S.-H., M.A.B., W.L., R.R.), Michael E. DeBakey Department of Surgery (O.O.O., D.L.C., T.C.L.), Department of Radiology (C.I.C., A.M.-R.), and Department of Pediatrics, Section of Neonatology (S.W., C.F.), Baylor College of Medicine, Houston, Texas USA
| | - Caraciolo Fernandes
- Texas Children's Fetal Center, Houston, Texas USA (I.S.W.B., N.S., O.O.O., D.L.C., T.C.L., C.I.C., A.M.-R., S.W., C.F., M.A.B., W.L., R.R.); and Department of Obstetrics and Gynecology (I.S.W.B., N.S., H.S.-H., M.A.B., W.L., R.R.), Michael E. DeBakey Department of Surgery (O.O.O., D.L.C., T.C.L.), Department of Radiology (C.I.C., A.M.-R.), and Department of Pediatrics, Section of Neonatology (S.W., C.F.), Baylor College of Medicine, Houston, Texas USA
| | - Michael A Belfort
- Texas Children's Fetal Center, Houston, Texas USA (I.S.W.B., N.S., O.O.O., D.L.C., T.C.L., C.I.C., A.M.-R., S.W., C.F., M.A.B., W.L., R.R.); and Department of Obstetrics and Gynecology (I.S.W.B., N.S., H.S.-H., M.A.B., W.L., R.R.), Michael E. DeBakey Department of Surgery (O.O.O., D.L.C., T.C.L.), Department of Radiology (C.I.C., A.M.-R.), and Department of Pediatrics, Section of Neonatology (S.W., C.F.), Baylor College of Medicine, Houston, Texas USA
| | - Wesley Lee
- Texas Children's Fetal Center, Houston, Texas USA (I.S.W.B., N.S., O.O.O., D.L.C., T.C.L., C.I.C., A.M.-R., S.W., C.F., M.A.B., W.L., R.R.); and Department of Obstetrics and Gynecology (I.S.W.B., N.S., H.S.-H., M.A.B., W.L., R.R.), Michael E. DeBakey Department of Surgery (O.O.O., D.L.C., T.C.L.), Department of Radiology (C.I.C., A.M.-R.), and Department of Pediatrics, Section of Neonatology (S.W., C.F.), Baylor College of Medicine, Houston, Texas USA
| | - Rodrigo Ruano
- Texas Children's Fetal Center, Houston, Texas USA (I.S.W.B., N.S., O.O.O., D.L.C., T.C.L., C.I.C., A.M.-R., S.W., C.F., M.A.B., W.L., R.R.); and Department of Obstetrics and Gynecology (I.S.W.B., N.S., H.S.-H., M.A.B., W.L., R.R.), Michael E. DeBakey Department of Surgery (O.O.O., D.L.C., T.C.L.), Department of Radiology (C.I.C., A.M.-R.), and Department of Pediatrics, Section of Neonatology (S.W., C.F.), Baylor College of Medicine, Houston, Texas USA.
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