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Narang K, Wyatt M, O'Leary P, Qureshi MY, Kolbe A, Stephens EH, Dearani JA, Ruano R. Novel approach to prenatal predictors of outcomes for fetuses with severe Ebstein anomaly. J Matern Fetal Neonatal Med 2023; 36:2271626. [PMID: 37904503 DOI: 10.1080/14767058.2023.2271626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 10/11/2023] [Indexed: 11/01/2023]
Abstract
OBJECTIVE Ebstein anomaly (EA) is a cardiac malformation with highly variable presentation and severity with limited perinatal management options. We present incorporation of fetal lung measurements into a multidisciplinary evaluation for counseling and predicting postnatal outcomes in patients with severe EA. METHODS Five fetuses with severe fetal EA were reviewed. Third trimester sonographic observed/expected total lung area (O/E TLA) and lung to head ratio (O/E LHR), fetal MRI total fetal lung volume ratio (O/E-TFLV), echocardiographic cardio-thoracic ratio (CT ratio), sonographic estimated fetal weight (EFW) by Hadlock formula and presence of hydrops, were used to guide perinatal management. RESULTS Three of five had appropriate fetal growth, were delivered at term in a cardiac operative suite, and underwent immediate intervention with good neonatal outcomes. Two had severe fetal growth restriction (FGR), CT ratios > 0.8 and O/E LHR and TLA < 25%. One of which delivered prematurely with neonatal demise and one suffered in utero demise at 34 weeks. CONCLUSIONS FGR, hydrops, increased CT ratio and reduced O/E LHR and TFLV are potential prognosticators of poor outcomes in severe EA, and should be validated in larger cohorts that would allow for a statistical analysis of the predictive utility of these measurements.
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Affiliation(s)
- Kavita Narang
- Maternal-Fetal Medicine Division, Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Michelle Wyatt
- Maternal-Fetal Medicine Division, Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Patrick O'Leary
- Division of Pediatric Cardiology, Department of Pediatrics and Adolescent Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - M Yasir Qureshi
- Division of Pediatric Cardiology, Department of Pediatrics and Adolescent Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Amy Kolbe
- Pediatric Radiology Division, Department of Radiology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Elizabeth H Stephens
- Department of Cardiovascular Surgery, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Joseph A Dearani
- Department of Cardiovascular Surgery, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Rodrigo Ruano
- Division Chief of Maternal-Fetal Medicine, Director UHealth Jackson Fetal Care, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
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Cerbelle V, Le Duc K, Lejeune S, Mur S, Lerisson H, Drumez E, Sfeir R, Bigot J, Verpillat P, Boukhris R, Vaast P, Mordacq C, Thumerelle C, Storme L, Deschildre A. Fetal Lung Volume Appears to Predict Respiratory Morbidity in Congenital Diaphragmatic Hernia. J Clin Med 2023; 12:jcm12041508. [PMID: 36836043 PMCID: PMC9961622 DOI: 10.3390/jcm12041508] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 02/02/2023] [Accepted: 02/09/2023] [Indexed: 02/17/2023] Open
Abstract
Congenital diaphragmatic hernia (CDH) is associated with pulmonary hypoplasia and respiratory morbidity. To assess whether respiratory morbidity during the first 2 years of life in infants with left-sided CDH is associated with fetal lung volume (FLV) evaluated by the observed-to-expected FLV ratio (o/e FLV) on antenatal magnetic resonance imaging (MRI). In this retrospective study, o/e FLV measures were collected. Respiratory morbidity in the first 2 years of life was studied according to two endpoints: treatment with inhaled corticosteroids for >3 consecutive months and hospitalization for any acute respiratory disease. The primary outcome was a favorable progression defined by the absence of either endpoint. Forty-seven patients were included. The median o/e FLV was 39% (interquartile range, 33-49). Sixteen (34%) infants were treated with inhaled corticosteroids and 13 (28%) were hospitalized. The most efficient threshold for a favorable outcome was an o/e FLV ≥ 44% with a sensitivity of 57%, specificity of 79%, negative predictive value of 56%, and positive predictive value of 80%. An o/e FLV ≥ 44% was associated with a favorable outcome in 80% of cases. These data suggest that lung volume measurement on fetal MRI may help to identify children at lower respiratory risk and improve information during pregnancy, patient characterization, decisions about treatment strategy and research, and personalized follow-up.
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Affiliation(s)
- Valentine Cerbelle
- Paediatric Pulmonology and Allergy Unit, Hôpital Jeanne de Flandre, CHU Lille, Université de Lille, F-59000 Lille, France
| | - Kévin Le Duc
- ULR2694 Metrics-Perinatal Environment and Health, Université de Lille, F-59000 Lille, France
- Department of Neonatology, Hôpital Jeanne de Flandre, CHU Lille, Université de Lille, F-59000 Lille, France
- Correspondence: ; Tel.: +33-3-20-44-58-89
| | - Stephanie Lejeune
- Paediatric Pulmonology and Allergy Unit, Hôpital Jeanne de Flandre, CHU Lille, Université de Lille, F-59000 Lille, France
| | - Sébastien Mur
- Department of Neonatology, Hôpital Jeanne de Flandre, CHU Lille, Université de Lille, F-59000 Lille, France
| | - Héloise Lerisson
- Pediatric Imaging Unit, Hôpital Jeanne de Flandre, CHU Lille, Université de Lille, F-59000 Lille, France
| | - Elodie Drumez
- ULR 2694-METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, CHU Lille, Université de Lille, F-59000 Lille, France
| | - Rony Sfeir
- Pediatric Surgery Unit, Hôpital Jeanne de Flandre, CHU Lille, Université de Lille, F-59000 Lille, France
| | - Julien Bigot
- Pediatric Imaging Unit, Hôpital Jeanne de Flandre, CHU Lille, Université de Lille, F-59000 Lille, France
- Jacquemars Giélée Imaging Center, F-59000 Lille, France
- Générale de Santé, La Louvière Ramsay Hôpital, F-59000 Lille, France
| | - Pauline Verpillat
- Pediatric Imaging Unit, Hôpital Jeanne de Flandre, CHU Lille, Université de Lille, F-59000 Lille, France
| | - Riadh Boukhris
- Department of Neonatology, Hôpital Jeanne de Flandre, CHU Lille, Université de Lille, F-59000 Lille, France
| | - Pascal Vaast
- Obstetrics and Gynecology Unit, Hôpital Jeanne de Flandre, CHU Lille, Université de Lille, F-59000 Lille, France
| | - Clémence Mordacq
- Paediatric Pulmonology and Allergy Unit, Hôpital Jeanne de Flandre, CHU Lille, Université de Lille, F-59000 Lille, France
| | - Caroline Thumerelle
- Paediatric Pulmonology and Allergy Unit, Hôpital Jeanne de Flandre, CHU Lille, Université de Lille, F-59000 Lille, France
| | - Laurent Storme
- ULR2694 Metrics-Perinatal Environment and Health, Université de Lille, F-59000 Lille, France
- Department of Neonatology, Hôpital Jeanne de Flandre, CHU Lille, Université de Lille, F-59000 Lille, France
| | - Antoine Deschildre
- Paediatric Pulmonology and Allergy Unit, Hôpital Jeanne de Flandre, CHU Lille, Université de Lille, F-59000 Lille, France
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3
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Amodeo I, Borzani I, Raffaeli G, Persico N, Amelio GS, Gulden S, Colnaghi M, Villamor E, Mosca F, Cavallaro G. The role of magnetic resonance imaging in the diagnosis and prognostic evaluation of fetuses with congenital diaphragmatic hernia. Eur J Pediatr 2022; 181:3243-3257. [PMID: 35794403 PMCID: PMC9395465 DOI: 10.1007/s00431-022-04540-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 06/23/2022] [Indexed: 11/04/2022]
Abstract
UNLABELLED In recent years, magnetic resonance imaging (MRI) has largely increased our knowledge and predictive accuracy of congenital diaphragmatic hernia (CDH) in the fetus. Thanks to its technical advantages, better anatomical definition, and superiority in fetal lung volume estimation, fetal MRI has been demonstrated to be superior to 2D and 3D ultrasound alone in CDH diagnosis and outcome prediction. This is of crucial importance for prenatal counseling, risk stratification, and decision-making approach. Furthermore, several quantitative and qualitative parameters can be evaluated simultaneously, which have been associated with survival, postnatal course severity, and long-term morbidity. CONCLUSION Fetal MRI will further strengthen its role in the near future, but it is necessary to reach a consensus on indications, methodology, and data interpretation. In addition, it is required data integration from different imaging modalities and clinical courses, especially for predicting postnatal pulmonary hypertension. This would lead to a comprehensive prognostic assessment. WHAT IS KNOWN • MRI plays a key role in evaluating the fetal lung in patients with CDH. • Prognostic assessment of CDH is challenging, and advanced imaging is crucial for a complete prenatal assessment and counseling. WHAT IS NEW • Fetal MRI has strengthened its role over ultrasound due to its technical advantages, better anatomical definition, superior fetal lung volume estimation, and outcome prediction. • Imaging and clinical data integration is the most desirable strategy and may provide new MRI applications and future research opportunities.
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Affiliation(s)
- Ilaria Amodeo
- grid.414818.00000 0004 1757 8749Neonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Della Commenda 12, 20122 Milan, Italy
| | - Irene Borzani
- grid.414818.00000 0004 1757 8749Pediatric Radiology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Genny Raffaeli
- grid.414818.00000 0004 1757 8749Neonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Della Commenda 12, 20122 Milan, Italy ,grid.4708.b0000 0004 1757 2822Department of Clinical Sciences and Community Health, Università Degli Studi Di Milano, Milan, Italy
| | - Nicola Persico
- grid.4708.b0000 0004 1757 2822Department of Clinical Sciences and Community Health, Università Degli Studi Di Milano, Milan, Italy ,grid.414818.00000 0004 1757 8749Department of Obstetrics and Gynecology, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Giacomo Simeone Amelio
- grid.414818.00000 0004 1757 8749Neonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Della Commenda 12, 20122 Milan, Italy
| | - Silvia Gulden
- grid.414818.00000 0004 1757 8749Neonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Della Commenda 12, 20122 Milan, Italy
| | - Mariarosa Colnaghi
- grid.414818.00000 0004 1757 8749Neonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Della Commenda 12, 20122 Milan, Italy
| | - Eduardo Villamor
- grid.412966.e0000 0004 0480 1382Department of Pediatrics, School for Oncology and Reproduction (GROW), Maastricht University Medical Center, University of Maastricht, MUMC+), Maastricht, the Netherlands
| | - Fabio Mosca
- grid.414818.00000 0004 1757 8749Neonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Della Commenda 12, 20122 Milan, Italy ,grid.4708.b0000 0004 1757 2822Department of Clinical Sciences and Community Health, Università Degli Studi Di Milano, Milan, Italy
| | - Giacomo Cavallaro
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Della Commenda 12, 20122, Milan, Italy.
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Predicting Perinatal Outcomes in Fetuses with Congenital Diaphragmatic Hernia Using Ultrasound and Magnetic Resonance Imaging. MATERNAL-FETAL MEDICINE 2021. [DOI: 10.1097/fm9.0000000000000103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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5
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Masselli G, Cozzi D, Ceccanti S, Laghi F, Giancotti A, Brunelli R. Fetal body MRI for fetal and perinatal management. Clin Radiol 2021; 76:708.e1-708.e8. [PMID: 34112509 DOI: 10.1016/j.crad.2021.05.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 05/05/2021] [Indexed: 12/19/2022]
Abstract
Fetal magnetic resonance imaging (MRI) has become a valuable adjunct to ultrasound (US) in diagnosing fetal abnormalities. This review is intended to highlight the contribution of MRI in parental counselling and perinatal treatment. A state-of-the-art fetal MRI protocol with experts of maternal-fetal medicine present in the MRI suite allows emphasis on patient-centred care and maximises therapeutic options.
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Affiliation(s)
- G Masselli
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy.
| | - D Cozzi
- Pediatric Surgery Unit, Sapienza University of Rome, Azienda Policlinico Umberto I, Rome, Italy
| | - S Ceccanti
- Pediatric Surgery Unit, Sapienza University of Rome, Azienda Policlinico Umberto I, Rome, Italy
| | - F Laghi
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - A Giancotti
- Department of Gynecological, Obstetrical, and Urological Sciences, Sapienza University, Rome, Italy
| | - R Brunelli
- Department of Gynecological, Obstetrical, and Urological Sciences, Sapienza University, Rome, Italy
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Cordier AG, Russo FM, Deprest J, Benachi A. Prenatal diagnosis, imaging, and prognosis in Congenital Diaphragmatic Hernia. Semin Perinatol 2020; 44:51163. [PMID: 31439324 DOI: 10.1053/j.semperi.2019.07.002] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Antenatal ultrasound screening identifies more than 60% of Congenital Diaphragmatic Hernia (CDH) cases and provides the opportunity for in utero referral to a tertiary care center for expert assessment and perinatal management. Prenatal assessment of fetuses with CDH has tremendously improved over the past ten years. The outcome may be predicted prenatally by medical imaging and advanced genetic testing. The combination of lung size and liver position determination by ultrasound measurements and MRI are widely accepted methods to stratify fetuses into groups that correlate not only with neonatal mortality but also with morbidity. Notwithstanding this, prediction of persistent pulmonary hypertension of the newborn still needs to be improved.
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Affiliation(s)
- Anne-Gael Cordier
- Department of Obstetrics and Gynecology, Hôpital Antoine Béclère, AP-HP, Université Paris Sud, 157 rue de la porte de Trivaux, 92140 CLAMART, APHP, Clamart, France; Centre Référence Maladie Rare, Hernie de Coupole Diaphragmatique, Clamart, France.
| | - Francesca M Russo
- Clinical Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium; Academic Department of Development and Regeneration, Cluster Woman and Child, KU Leuven, Leuven, Belgium
| | - Jan Deprest
- Clinical Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium; Academic Department of Development and Regeneration, Cluster Woman and Child, KU Leuven, Leuven, Belgium; Institute for Women's Health, University College London, London, UK
| | - Alexandra Benachi
- Department of Obstetrics and Gynecology, Hôpital Antoine Béclère, AP-HP, Université Paris Sud, 157 rue de la porte de Trivaux, 92140 CLAMART, APHP, Clamart, France; Centre Référence Maladie Rare, Hernie de Coupole Diaphragmatique, Clamart, France
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7
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Abstract
Because congenital diaphragmatic hernia (CDH) is characterized by a spectrum of severity, risk stratification is an essential component of care. In both the prenatal and postnatal periods, accurate prediction of outcomes may inform clinical decision-making, care planning, and resource allocation. This review examines the history and utility of the most well-established risk prediction tools currently available, and provides recommendations for their optimal use in the management of CDH patients.
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Affiliation(s)
- Tim Jancelewicz
- Le Bonheur Children's Hospital, University of Tennessee Health Science Center, 49 North Dunlap St., Second Floor, Memphis, TN, 38112, USA.
| | - Mary E Brindle
- Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
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8
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Jancelewicz T, Brindle ME, Harting MT, Tolley EA, Langham MR, Lally PA, Gosain A, Storgion SA, Kays DW. Extracorporeal Membrane Oxygenation (ECMO) Risk Stratification in Newborns with Congenital Diaphragmatic Hernia (CDH). J Pediatr Surg 2018; 53:1890-1895. [PMID: 29754878 DOI: 10.1016/j.jpedsurg.2018.04.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 03/05/2018] [Accepted: 04/08/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND A means for early postnatal stratification of ECMO risk in CDH newborns could be used to comparatively assess the utilization and outcomes of ECMO use between centers. While multiple CDH mortality risk calculators are available, no validated tool exists specifically for prediction of ECMO use. The purpose of this study was to derive and validate an ECMO risk stratification model. METHODS The study population was obtained from CDH Study Group registry for the period between 2007 and 2016. Only centers offering ECMO were included. The cohort was restricted to ECMO candidates and then divided into derivation and validation sets. Using all relevant perinatal predictors in the registry, univariate analysis was performed for the composite outcome of ECMO use or death without ECMO use. The model was derived using the derivation cohort with multivariable logistic regression and automatic stepwise forward selection (P < 0.05 for qualifying variables), and a c-statistic was obtained. The model was then tested on the validation cohort. Sample reuse validation and bootstrap validation were performed. The validated model was then tested for accuracy on CDH subgroups. RESULTS There were 1992 patients in the derivation cohort. Four significant variables were identified in the final ECMO risk model: 1-min and 5-min Apgar scores and highest and lowest post-ductal partial pressure of CO2 during the first 24 h of life. The model c-statistic was 0.824 which was confirmed with cross-validation and bootstrap optimism correction. The validation cohort c-statistic was 0.823 (N = 993). The model had good discrimination for left and right CDH, inborn and outborn patients, patients born before and after 2011, and high and low volume centers. The model performed significantly better for postnatally diagnosed patients. CONCLUSIONS This study represents proof-of-concept that a risk model can accurately estimate the probability of ECMO use in CDH newborns. This stratification could assist centers as a metric for assessment of ECMO usage and outcomes. Refinement and prospective validation of this model should be carried out prior to clinical application. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Tim Jancelewicz
- Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, TN, USA.
| | - Mary E Brindle
- Alberta Children's Hospital and Cumming Medical School, University of Calgary, Calgary, AB, Canada
| | - Matthew T Harting
- University of Texas McGovern Medical School and Children's Memorial Hermann Hospital, Houston, TX, USA
| | - Elizabeth A Tolley
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Max R Langham
- Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Pamela A Lally
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Ankush Gosain
- Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Stephanie A Storgion
- Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, TN, USA
| | - David W Kays
- Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
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9
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Histogram based analysis of lung perfusion of children after congenital diaphragmatic hernia repair. Magn Reson Imaging 2018; 48:42-49. [DOI: 10.1016/j.mri.2017.11.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 11/17/2017] [Accepted: 11/21/2017] [Indexed: 11/18/2022]
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10
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Value of Fetal MRI in the Era of Fetal Therapy for Management of Abnormalities Involving the Chest, Abdomen, or Pelvis. AJR Am J Roentgenol 2018. [DOI: 10.2214/ajr.17.18948] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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11
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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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12
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Russo FM, Eastwood MP, Keijzer R, Al-Maary J, Toelen J, Van Mieghem T, Deprest JA. Lung size and liver herniation predict need for extracorporeal membrane oxygenation but not pulmonary hypertension in isolated congenital diaphragmatic hernia: systematic review and meta-analysis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2017; 49:704-713. [PMID: 27312047 DOI: 10.1002/uog.16000] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 05/29/2016] [Accepted: 06/13/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES To identify antenatal predictors of persistent pulmonary hypertension (PPH) and the need for extracorporeal membrane oxygenation (ECMO) in fetuses with congenital diaphragmatic hernia (CDH). METHODS We performed a systematic literature review on antenatal diagnostic tests in fetuses with isolated CDH. The primary outcomes assessed were PPH within 28 days of age and the need for ECMO. Quality of studies was assessed with the QUADAS-2 tool. Meta-analysis was performed when at least three studies reported on the same test. Sensitivity analysis was performed according to prenatal management of CDH (tracheal occlusion vs expectant management). RESULTS Thirty-eight studies met the inclusion criteria. Fifteen reported on the incidence of PPH only, 19 on the need for ECMO only and four reported on both outcomes. The general quality of the studies was moderate; most studies were retrospective (61%) and single-center series (92%). One study included only fetuses undergoing tracheal occlusion, 22 included only fetuses managed expectantly in utero and 15 included both populations. We could not identify antenatal predictors of PPH. The need for ECMO was predicted by parameters indicative of lung size: lung-to-head ratio (LHR) (relative risk (RR) for LHR < 1, 1.65 (95% CI, 1.27-2.14)) and observed/expected LHR (standardized mean difference (SMD), -0.70 (95% CI, -0.98 to -0.42)) measured by ultrasound and observed/expected total lung volume (SMD, -1.00 (95% CI, -1.52 to -0.48)) measured by magnetic resonance imaging. Liver herniation was also associated with an increased risk of need for ECMO (RR, 3.04 (95% CI, 2.23-4.14)). These results were confirmed by a sensitivity analysis of studies that included only expectantly managed cases. Data on vascular assessment for the prediction of PPH could not be pooled as most of the parameters were evaluated in a single series or in different series by the same principal investigator. CONCLUSIONS In fetuses with CDH, lung size and liver herniation predict the need for ECMO, however a predictor for PPH is still lacking. Further studies aimed at diagnosing impaired vascular development in utero should therefore be undertaken. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- F M Russo
- Academic Department of Development and Regeneration, Organ Systems Cluster, KU Leuven, Leuven, Belgium
- Clinical Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium
| | - M P Eastwood
- Academic Department of Development and Regeneration, Organ Systems Cluster, KU Leuven, Leuven, Belgium
| | - R Keijzer
- Departments of Surgery, Pediatrics & Child Health and Physiology, University of Manitoba, and Children's Hospital Research Institute of Manitoba, Biology of Breathing, Winnipeg, Manitoba, Canada
| | - J Al-Maary
- Departments of Surgery, Pediatrics & Child Health and Physiology, University of Manitoba, and Children's Hospital Research Institute of Manitoba, Biology of Breathing, Winnipeg, Manitoba, Canada
| | - J Toelen
- Academic Department of Development and Regeneration, Organ Systems Cluster, KU Leuven, Leuven, Belgium
- Clinical Department of Pediatrics, University Hospitals Leuven, Leuven, Belgium
| | - T Van Mieghem
- Academic Department of Development and Regeneration, Organ Systems Cluster, KU Leuven, Leuven, Belgium
- Clinical Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium
| | - J A Deprest
- Academic Department of Development and Regeneration, Organ Systems Cluster, KU Leuven, Leuven, Belgium
- Clinical Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium
- Institute of Women's Health, University College London Hospitals, London, UK
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Abstract
In congenital diaphragmatic hernia (CDH), herniation of the abdominal organs into the fetal chest causes pulmonary hypoplasia and pulmonary hypertension, the main causes of neonatal mortality. As antenatal ultrasound screening improves, the risk of postnatal death can now be better predicted, allowing for the identification of fetuses that might most benefit from a prenatal intervention. Fetoscopic tracheal occlusion is being evaluated in a large international randomized controlled trial. We present the antenatal imaging approaches that can help identify fetuses that might benefit from antenatal therapy, and review the evolution of fetal surgery for CDH to date.
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Affiliation(s)
- Titilayo Oluyomi-Obi
- Section of Maternal Fetal Medicine, Department of Obstetrics and Gynaecology, University of Calgary, 1403 29 Street NW, Calgary, Alberta.
| | - Tim Van Mieghem
- Fetal Medicine Unit, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Greg Ryan
- Fetal Medicine Unit, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
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Antenatal predictors of outcome in prenatally diagnosed congenital diaphragmatic hernia (CDH). J Pediatr Surg 2017; 52:881-888. [PMID: 28095996 DOI: 10.1016/j.jpedsurg.2016.12.008] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 12/02/2016] [Accepted: 12/12/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND Pulmonary hypoplasia is the main cause of mortality in isolated congenital diaphragmatic hernia (CDH) and its prediction is paramount when counseling parents. We sought to identify antenatal parameters that predicted neonatal mortality in CDH. METHOD Search was conducted in MEDLINE, EMBASE, Cochrane Database of Systematic reviews, PubMed, Scopus, and Web of Science on the ability of lung-to-head ratio (LHR), observed-to-expected LHR (o/e LHR), total fetal lung volume (TFLV), o/e TFLV, percentage predicted lung volume (PPLV) and degree of liver herniation to predict neonatal morbidity and mortality in fetuses with CDH. Primary outcome was perinatal survival and secondary was the use of extracorporeal membrane oxygenation (ECMO). RESULTS Until April 2016, 1067 articles were found, of which 22 were included in our meta-analysis. This showed that the odds of survival with LHR <1.0 and liver herniation on ultrasound were 0.14 (CI 0.10-0.27) and 0.21 (CI 0.13-0.35) respectively. Mean LHR, o/e LHR, absolute TFLV, o/e TFLV, PPLV and liver herniation all predicted survival, however o/e LHR and o/e TFLV performed best in this prediction. When the longest diameter measurement method was used, the o/e TFLV (summary area under curve (AUC) 0.8) was slightly superior to o/e LHR (summary AUC 0.78). This difference disappeared when LHR was measured by the trace method. The most discriminatory threshold for O/E LHR and O/E TFLV was 25%. LHR <1 was predictive of extracorporeal life support (ECLS) use. CONCLUSION O/E LHR, o/e TFLV (thresholds of 25%) and liver herniation are good predictors of mortality in CDH. LEVEL OF EVIDENCE Level II Type of study: Systematic review and meta-analysis.
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Hinton CF, Siffel C, Correa A, Shapira SK. Survival Disparities Associated with Congenital Diaphragmatic Hernia. Birth Defects Res 2017; 109:816-823. [PMID: 28398654 DOI: 10.1002/bdr2.1015] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 01/24/2017] [Accepted: 01/26/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND We assessed sociodemographic and clinical factors that are associated with survival among infants with congenital diaphragmatic hernia (CDH). METHODS Using data from the Metropolitan Atlanta Congenital Defects Program, we ascertained 150 infants born with CDH between 1979 and 2003 and followed via linkage with state vital records and the National Death Index. Kaplan-Meier survival probabilities and adjusted hazard ratios (HRs) were calculated for socioeconomic and clinical characteristics. RESULTS Survival increased from 40 to 62% over the study period. White infants born before 1988 were 2.9 times less likely to survive than those born after 1988. Black infants' survival did not show significant improvement after 1988. White infants' survival was not significantly affected by poverty, whereas black infants born in higher levels of poverty were 2.7 times less likely to survive than black infants born in lower levels of neighborhood poverty. White infants with multiple major birth defects were 2.6 times less likely to survive than those with CDH alone. The presence of multiple defects was not significantly associated with survival among black infants. CONCLUSIONS Survival among infants and children with CDH has improved over time among whites, but not among blacks. Poverty is associated with lower survival among blacks, but not among whites. The presence of multiple defects is associated with lower survival among whites, but not among blacks. The differential effects of poverty and race should be taken into account when studying disparities in health outcomes. Birth Defects Research 109:816-823, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Cynthia F Hinton
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Csaba Siffel
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia.,College of Allied Health Sciences, Augusta University, Augusta, Georgia
| | - Adolfo Correa
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia.,University of Mississippi Medical Center, Jackson, Mississippi
| | - Stuart K Shapira
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
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Correlation of Observed-to-Expected MRI Fetal Lung Volume and Ultrasound Lung-to-Head Ratio at Different Gestational Times in Fetuses With Congenital Diaphragmatic Hernia. AJR Am J Roentgenol 2016; 206:856-66. [PMID: 27003054 DOI: 10.2214/ajr.15.15018] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study is to compare the observed-to-expected MRI fetal lung volume and the observed-to-expected ultrasound lung-to-head ratio intraindividually for prediction of survival, the need for extracorporeal membrane oxygenation (ECMO) therapy, and the development of chronic lung disease (CLD) at different times of gestation (< 28, 28-32, and > 32 weeks) in fetuses with congenital diaphragmatic hernia (CDH), and to analyze the intraindividual correlation of observed-to-expected MRI fetal lung volume and observed-to-expected ultrasound lung-to-head ratio. MATERIALS AND METHODS Two hundred one fetuses were included in our study. Observed-to-expected MRI fetal lung volume and observed-to-expected ultrasound lung-to-head ratio were calculated for 270 MRI and ultrasound examinations performed within 72 hours of each other. The prognostic accuracy of observed-to-expected MRI fetal lung volume and observed-to-expected ultrasound lung-to-head ratio was assessed by performing ROC analysis. Correlation was determined using linear regression analysis. RESULTS The results revealed statistically significant differences between the observed-to-expected MRI fetal lung volume and observed-to-expected ultrasound lung-to-head ratio for the prediction of survival, the need for ECMO therapy, and the development of CLD in fetuses with left-sided CDH (p ≤ 0.0444), with the highest prognostic accuracy for survival (AUC = 0.863). Observed-to-expected MRI fetal lung volume and observed-to-expected ultrasound lung-to-head ratio correlated statistically significantly (p < 0.0001) for left-sided CDH with correlation coefficients (r) of 0.71, 0.71, and 0.56 for early, intermediate, and late times of gestation, respectively. The correlation was not statistically significant at any time for right-sided CDH (p ≥ 0.3947; r ≤ 0.26). CONCLUSION Observed-to-expected MRI fetal lung volume and observed-to-expected ultrasound lung-to-head ratio are valuable prognostic parameters for prenatal prediction of survival, the need for ECMO therapy, and the development of CLD in fetuses with left-sided CDH at all times of gestation. Observed-to-expected MRI fetal lung volume and observed-to-expected ultrasound lung-to-head ratio correlate statistically significantly for left-sided CDH, and the correlation is best before 32 weeks' gestation, but they do not correlate statistically significantly for right-sided CDH.
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Zöllner FG, Daab M, Weidner M, Sommer V, Zahn K, Schaible T, Weisser G, Schoenberg SO, Neff KW, Schad LR. Semi-automatic lung segmentation of DCE-MRI data sets of 2-year old children after congenital diaphragmatic hernia repair: Initial results. Magn Reson Imaging 2015; 33:1345-1349. [DOI: 10.1016/j.mri.2015.08.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Accepted: 08/08/2015] [Indexed: 11/17/2022]
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Congenital diaphragmatic hernia: does gestational age at diagnosis matter when evaluating morbidity and mortality? Am J Obstet Gynecol 2015; 213:535.e1-7. [PMID: 26070705 DOI: 10.1016/j.ajog.2015.06.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 04/12/2015] [Accepted: 06/01/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The objective of the investigation was to study the relationship between gestational age at diagnosis and mortality and morbidity in fetuses with an isolated congenital diaphragmatic hernia. STUDY DESIGN Between January 2008 and November 2013, 377 live births with isolated congenital diaphragmatic hernia diagnosed antenatally at a known gestational age were recorded in the database of the French National Center for Rare Diseases. The primary outcome studied was mortality estimated at 28 days and at 6 months. The secondary outcome was morbidity evaluated by pulmonary arterial hypertension at 48 hours, oxygen therapy dependence at 28 days, oral disorders, enteral feeding, and prosthetic patch repair. Analyses were adjusted for the main factors of congenital diaphragmatic hernia severity (side of the hernia, thoracic herniation of the liver, gestational age at birth, lung-to-head ratio, and prenatal treatment by tracheal occlusion. RESULTS Mortality rates at 28 days decreased significantly (P < .001) when gestational age at diagnosis increased: 61.1%, 39.2%, and 10.4% for a diagnosis in the first, second, and third trimester, respectively. Adjusted odds ratios were 3.12 [95% confidence interval, 1.86-5.25] and 0.35 [95% confidence interval, 0.18-0.66] for a diagnosis in the first and third trimesters, respectively, compared with a diagnosis in the second trimester. Similarly, morbidity decreased significantly when gestational age at diagnosis increased, and the trend remained significant after adjustment for the main factors of congenital diaphragmatic hernia severity (P < .001). CONCLUSION Gestational age at diagnosis is an independent predictor of postnatal prognosis for children presenting an isolated congenital diaphragmatic hernia and should be taken into account when estimating postnatal morbidity and mortality.
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Cordier AG, Jani JC, Cannie MM, Rodó C, Fabietti I, Persico N, Saada J, Carreras E, Senat MV, Benachi A. Stomach position in prediction of survival in left-sided congenital diaphragmatic hernia with or without fetoscopic endoluminal tracheal occlusion. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2015; 46:155-161. [PMID: 25487417 DOI: 10.1002/uog.14759] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 12/02/2014] [Accepted: 12/04/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To investigate the value of fetal stomach position in predicting postnatal outcome in left-sided congenital diaphragmatic hernia (CDH) with and without fetoscopic endoluminal tracheal occlusion (FETO). METHODS This was a retrospective review of CDH cases that were expectantly managed or treated with FETO, assessed from May 2008 to October 2013, in which we graded, on a scale of 1-4, stomach position on the four-chamber view of the heart with respect to thoracic structures. Logistic regression analysis was used to investigate the effect of management center (Paris, Brussels, Barcelona, Milan), stomach grading, observed-to-expected lung area-to-head circumference ratio (O/E-LHR), gestational age at delivery, birth weight in expectantly managed CDH, gestational ages at FETO and at removal and period of tracheal occlusion, on postnatal survival in CDH cases treated with FETO. RESULTS We identified 67 expectantly managed CDH cases and 47 CDH cases that were treated with FETO. In expectantly managed CDH, stomach position and O/E-LHR predicted postnatal survival independently. In CDH treated with FETO, stomach position and gestational age at delivery predicted postnatal survival independently. CONCLUSION In left-sided CDH with or without FETO, stomach position is predictive of postnatal survival.
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Affiliation(s)
- A-G Cordier
- Department of Obstetrics, Gynaecology and Reproductive Medicine and Centre Maladies Rares: Hernie de Coupole Diaphragmatique, Hospital Antoine Beclere, APHP, Paris Sud University, Clamart, Paris, France
| | - J C Jani
- Department of Obstetrics and Gynaecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - M M Cannie
- Department of Radiology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
- Department of Radiology, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - C Rodó
- Department of Obstetrics, Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - I Fabietti
- Department of Obstetrics and Gynecology 'L. Mangiagalli', Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - N Persico
- Department of Obstetrics and Gynecology 'L. Mangiagalli', Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - J Saada
- Department of Obstetrics, Gynaecology and Reproductive Medicine and Centre Maladies Rares: Hernie de Coupole Diaphragmatique, Hospital Antoine Beclere, APHP, Paris Sud University, Clamart, Paris, France
| | - E Carreras
- Department of Obstetrics, Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - M-V Senat
- Department of Obstetrics and Gynaecology, Hospital Bicêtre, APHP, Paris Sud University, Kremlin Bicêtre, Paris, France
| | - A Benachi
- Department of Obstetrics, Gynaecology and Reproductive Medicine and Centre Maladies Rares: Hernie de Coupole Diaphragmatique, Hospital Antoine Beclere, APHP, Paris Sud University, Clamart, Paris, France
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Klein T, Semaan A, Kellner M, Ritgen J, Boemers T, Stressig R. Coincidence of congenital left-sided diaphragmatic hernia and ductus venosus agenesis: Relation between altered hemodynamic flow and lung-to-head-ratio? JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2015. [DOI: 10.1016/j.epsc.2015.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Abstract
Over the past 20 years, prenatal detection of congenital diaphragmatic hernia (CDH) has improved worldwide, reaching up to 60% in Europe. Pulmonary hypoplasia and persistent pulmonary hypertension are the two main determinants of neonatal mortality and morbidity, so new tools have been focused on their evaluation. Fetal surgery for severe cases requires proper evaluation of the prognosis of fetuses with CDH. Observed-to-expected lung-to-head ratio, liver position, and total lung volume measured by magnetic resonance are the prognostic factors most often used, and have been shown to correlate not only with neonatal mortality but also with morbidity. In daily practice, pulmonary hypertension by itself, although most often associated with lung hypoplasia, is more difficult to predict.
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Danzer E, Hedrick HL. Controversies in the management of severe congenital diaphragmatic hernia. Semin Fetal Neonatal Med 2014; 19:376-84. [PMID: 25454678 DOI: 10.1016/j.siny.2014.10.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Despite years of progress in perinatal care, severe congenital diaphragmatic hernia (CDH) remains a clinical challenge. Controversies include almost every facet of clinical care: the definition of severe CDH by prenatal and postnatal criteria, fetal surgical intervention, ventilator management, pulmonary hypertension management, use of extracorporeal membrane oxygenation, surgical considerations, and long-term follow-up. Breakthroughs are likely only possible by sharing of experience, collaboration between institutions and innovative therapies within well-designed multicenter clinical trials.
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Affiliation(s)
- Enrico Danzer
- The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia, PA, USA; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Holly L Hedrick
- The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia, PA, USA; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
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Prenatal MR imaging of congenital diaphragmatic hernias: association of MR fetal lung volume with the need for postnatal prosthetic patch repair. Eur Radiol 2014; 25:258-66. [PMID: 25182631 DOI: 10.1007/s00330-014-3410-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 08/16/2014] [Accepted: 08/22/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To assess whether the need for postnatal prosthetic patch repair of the diaphragmatic defect in neonates with a congenital diaphragmatic hernia (CDH) is associated with the antenatal measured observed-to-expected magnetic resonance fetal lung volume (o/e MR-FLV). METHODS The o/e MR-FLV was calculated in 247 fetuses with isolated CDH. Logistic regression analysis was used to assess the prognostic value of the individual o/e MR-FLV for association with the need for postnatal patch repair. RESULTS Seventy-seven percent (77%) of patients with a CDH (190/247) required prosthetic patch repair and the defect was closed primarily in 23% (57/247). Patients requiring a patch had a significantly lower o/e MR-FLV (27.7 ± 10.2%) than patients with primary repair (40.8 ± 13.8%, p < 0.001, AUC = 0.786). With an o/e MR-FLV of 20%, 92% of the patients required patch repair, compared to only 24% with an o/e MR-FLV of 60%. The need for a prosthetic patch was further influenced by the fetal liver position (herniation/no herniation) as determined by magnetic resonance imaging (MRI; p < 0.001). Fetal liver position, in addition to the o/e MR-FLV, improves prognostic accuracy (AUC = 0.827). CONCLUSION Logistic regression analysis based on the o/e MR-FLV is useful for prenatal estimation of the prosthetic patch requirement in patients with a CDH. In addition to the o/e MR-FLV, the position of the liver as determined by fetal MRI helps improve prognostic accuracy. KEY POINTS • The o/e MR-FLV is associated with the need for postnatal patch repair in CDH. • The need for a patch is associated with a significantly lower o/e MR-FLV (p < 0.001). • The patch requirement is also influenced by fetal liver position. • Fetal liver position, in addition to the o/e MR-FLV, improves prognostic accuracy. • CDH-fetuses with a high probability for patch requirement can be identified prenatally.
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MRI-based ratio of fetal lung volume to fetal body volume as a new prognostic marker in congenital diaphragmatic hernia. AJR Am J Roentgenol 2014; 202:1330-6. [PMID: 24848832 DOI: 10.2214/ajr.13.11023] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The objective of our study was to evaluate the prognostic accuracy of the MRI-based ratio of fetal lung volume (FLV) to fetal body volume (FBV) for predicting survival and the need for extracorporeal membrane oxygenation (ECMO) therapy in fetuses with congenital diaphragmatic hernia (CDH). MATERIALS AND METHODS MRI was performed in 96 fetuses (34 females and 62 males; mean gestational age, 33 ± 5 [SD] weeks; range, 23-39 weeks) with CDH and 44 healthy control subjects. FLV and FBV were measured for each fetus by one of three investigators, and we calculated the FLV/FBV ratio. Additionally, a subgroup analysis of growth-restricted fetuses was performed. Logistic regression analysis was used to model the dependence of survival and ECMO requirement on the FLV/FBV ratio. Prognostic accuracy was evaluated by applying the area under the curve (AUC). RESULTS Seventy-eight of the 96 (81%) fetuses survived and 35 (36%) neonates needed ECMO therapy. The FLV/FBV ratio was significantly higher in fetuses who survived (p < 0.0001; AUC = 0.829). Neonates who received ECMO therapy showed a significantly lower prenatal FLV/FBV ratio (p = 0.0001; AUC = 0.811) than neonates who did not need ECMO therapy. A subgroup analysis (n = 13) showed a trend toward a higher FLV/FBV ratio of survivors in comparison with nonsurvivors (p = 0.065; AUC = 0.875). CONCLUSION In our study, the MRI-based FLV/FBV ratio was able to predict neonatal survival and ECMO requirement in children with CDH with high accuracy. Unlike other prognostic parameters, FLV/FBV ratio is independent of a reference to a control group and may enhance prognostic accuracy particularly in growth-restricted neonatal patients.
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Zamora IJ, Olutoye OO, Cass DL, Fallon SC, Lazar DA, Cassady CI, Mehollin-Ray AR, Welty SE, Ruano R, Belfort MA, Lee TC. Prenatal MRI fetal lung volumes and percent liver herniation predict pulmonary morbidity in congenital diaphragmatic hernia (CDH). J Pediatr Surg 2014; 49:688-93. [PMID: 24851749 DOI: 10.1016/j.jpedsurg.2014.02.048] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2014] [Accepted: 02/13/2014] [Indexed: 11/27/2022]
Abstract
PURPOSE The purpose of this study was to determine whether prenatal imaging parameters are predictive of postnatal CDH-associated pulmonary morbidity. METHODS The records of all neonates with CDH treated from 2004 to 2012 were reviewed. Patients requiring supplemental oxygen at 30 days of life (DOL) were classified as having chronic lung disease (CLD). Fetal MRI-measured observed/expected total fetal lung volume (O/E-TFLV) and percent liver herniation (%LH) were recorded. Receiver operating characteristic (ROC) curves and multivariate regression were applied to assess the prognostic value of O/E-TFLV and %LH for development of CLD. RESULTS Of 172 neonates with CDH, 108 had fetal MRIs, and survival was 76%. 82% (89/108) were alive at DOL 30, 46 (52%) of whom had CLD. Neonates with CLD had lower mean O/E-TFLV (30 vs.42%; p=0.001) and higher %LH (21.3±2.8 vs.7.1±1.8%; p<0.001) compared to neonates without CLD. Using ROC analysis, the best cutoffs in predicting CLD were an O/E-TFLV<35% (AUC=0.74; p<0.001) and %LH>20% (AUC=0.78; p<0.001). On logistic regression, O/E-TFLV<35% and a %LH>20% were highly associated with indicators of long-term pulmonary sequelae. On multivariate analysis, %LH was the strongest predictor of CLD in patients with CDH (OR: 10.96, 95%CI: 2.5-48.9, p=0.002). CONCLUSION Prenatal measurement of O/E-TFLV and %LH is predictive of CDH pulmonary morbidity and can aid in establishing parental expectations of postnatal outcomes.
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Affiliation(s)
- Irving J Zamora
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX, USA; The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Oluyinka O Olutoye
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX, USA; The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA; Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA
| | - Darrell L Cass
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX, USA; The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA; Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA
| | - Sara C Fallon
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX, USA; The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - David A Lazar
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX, USA; The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Christopher I Cassady
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX, USA; Department of Radiology, Baylor College of Medicine, Houston, TX, USA
| | - Amy R Mehollin-Ray
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX, USA; Department of Radiology, Baylor College of Medicine, Houston, TX, USA
| | - Stephen E Welty
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX, USA; Department of Pediatrics, Division of Neonatology, Baylor College of Medicine, Houston, TX, USA
| | - Rodrigo Ruano
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX, USA; Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA
| | - Michael A Belfort
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX, USA; Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA
| | - Timothy C Lee
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX, USA; The Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA.
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Kehl S, Siemer J, Brunnemer S, Weiss C, Eckert S, Schaible T, Sütterlin M. Prediction of postnatal outcomes in fetuses with isolated congenital diaphragmatic hernias using different lung-to-head ratio measurements. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2014; 33:759-767. [PMID: 24764330 DOI: 10.7863/ultra.33.5.759] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES The purpose of this study was to compare different methods for measuring the fetal lung area-to-head circumference ratio and to investigate their prediction of postpartum survival and the need for neonatal extracorporeal membrane oxygenation (ECMO) therapy in fetuses with isolated congenital diaphragmatic hernias. METHODS This prospective study included 118 fetuses of at least 20 weeks' gestation with isolated left-sided congenital diaphragmatic hernias. The lung-to-head ratio was measured with 3 different methods (longest diameter, anteroposterior diameter, and tracing). To eliminate the influence of gestational age, the observed-to-expected lung-to-head ratio was calculated. Receiver operating characteristic (ROC) curves were calculated for the statistical prediction of survival and need for ECMO therapy by the observed-to-expected lung-to-head ratio measured with the different methods. RESULTS For survival and ECMO necessity 118 and 102 cases (16 neonates were not eligible for ECMO) were assessed, respectively. For prediction of postpartum survival and ECMO necessity, the areas under the ROC curves and 95% confidence intervals showed very similar results for the 3 methods for prediction of survival (tracing, 0.8445 [0.7553-0.9336]; longest diameter, 0.8248 [0.7360-0.9136]; and anteroposterior diameter, 0.8002 [0.7075-0.8928]) and for ECMO necessity (tracing, 0.7344 [0.6297-0.8391]; longest diameter, 0.7128 [0.6027-0.8228]; and anteroposterior diameter, 0.7212 [0.6142-0.8281]). Comparisons between the areas under the ROC curves showed that the tracing method was superior to the anteroposterior diameter method in predicting postpartum survival (P = .0300). CONCLUSIONS Lung-to-head ratio and observed-to-expected lung-to-head ratio measurements were shown to accurately predict postnatal survival and the need for ECMO therapy in fetuses with left-sided congenital diaphragmatic hernias. Tracing the limits of the lungs seems to be the favorable method for calculating the fetal lung area.
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Affiliation(s)
- Sven Kehl
- Department of Obstetrics and Gynecology, University Medical Center Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.
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Cordier AG, Cannie MM, Guilbaud L, De Laveaucoupet J, Martinovic J, Nowakowska D, Milejska-Lewandowska M, Rodó C, Viaris de Lesegno B, Votino C, Senat MV, Jani JC, Benachi A. Stomach position versus liver-to-thoracic volume ratio in left-sided congenital diaphragmatic hernia. J Matern Fetal Neonatal Med 2014; 28:190-5. [DOI: 10.3109/14767058.2014.906576] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
Congenital diaphragmatic hernia (CDH) is a congenital defect in the diaphragm that allows herniation of abdominal contents into the fetal chest and leads to varying degrees of pulmonary hypoplasia and pulmonary hypertension. Advances in prenatal diagnosis and the institution of standardized delivery and postnatal care protocols have led to improved survival. Fetal endoscopic tracheal occlusion shows early promise for patients with the most severe CDH, but prospective randomized data is still required. CDH survivors have a variety of associated morbidities that require long-term follow-up and early intervention strategies for optimal care.
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Affiliation(s)
- Andrea Badillo
- Children's National Medical Center, 111 Michigan Avenue NW, Suite W4-200, Washington, DC 20008.
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Kehl S, Eckert S, Berlit S, Tuschy B, Sütterlin M, Siemer J. New formulas for calculating the lung-to-head ratio in healthy fetuses between 20 and 40 weeks' gestation. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2013; 32:1939-1943. [PMID: 24154897 DOI: 10.7863/ultra.32.11.1939] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVES The purpose of this study was to develop new formulas for the expected fetal lung area-to-head circumference ratio in normal singleton pregnancies between 20 and 40 weeks' gestation. METHODS The lung-to-head ratio and complete fetal biometric parameters of 126 fetuses between 20 and 40 weeks' gestation were prospectively measured. The lung-to-head ratio was measured by 3 different methods (longest diameter, anteroposterior diameter, and tracing). Formulas for predicting right and left lung-to-head ratios with regard to gestational age and biometric parameters were derived by stepwise regression analysis. RESULTS New formulas for calculating right and left lung-to-head ratios by each measurement method were derived. The formulas included gestational age only and no biometric parameters. CONCLUSIONS The new formulas for estimating the expected lung-to-head ratio by the 3 different methods in normal singleton pregnancies up to 40 weeks' gestation may help improve the prognostic power of observed-to-expected lung-to-head ratio assessment in fetuses with congenital diaphragmatic hernias.
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Affiliation(s)
- Sven Kehl
- Department of Obstetrics and Gynecology, University Medical Center Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.
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Repetitive MR measurements of lung volume in fetuses with congenital diaphragmatic hernia: individual development of pulmonary hypoplasia during pregnancy and calculation of weekly lung growth rates. Eur Radiol 2013; 24:312-9. [DOI: 10.1007/s00330-013-3011-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Revised: 08/18/2013] [Accepted: 08/21/2013] [Indexed: 02/07/2023]
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31
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Periodic MRI lung volume assessment in fetuses with congenital diaphragmatic hernia: prediction of survival, need for ECMO, and development of chronic lung disease. AJR Am J Roentgenol 2013; 201:419-26. [PMID: 23883224 DOI: 10.2214/ajr.12.8655] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of the study was to investigate the ability to predict survival, need for extracorporeal membrane oxygenation (ECMO), and incidence of chronic lung disease in patients with congenital diaphragmatic hernia in the context of a classification into three different times of gestation (< 28, 28-32, and > 32 weeks) by assessing the ratio between observed and expected MRI fetal lung volume. MATERIALS AND METHODS The data analysis included 226 fetuses with congenital diaphragmatic hernia. MRI was performed at different times of gestation with a T2-weighted HASTE sequence. Receiver operating characteristic curve analysis was performed to investigate the prognostic value of assessment of the ratio between observed and expected MRI fetal lung volumes at different stages of fetal growth. RESULTS For all reviewed times of gestation, the ratio between observed and expected MRI fetal lung volumes had almost equivalent statistically significant differences for neonatal survival (p ≤ 0.0029), need for ECMO therapy (p ≤ 0.0195), and development of chronic lung disease (p ≤ 0.0064). Results with high prognostic accuracy for early and for medium and late times in gestation also were obtained. Receiver operating characteristic analysis showed the highest area under the curve (≥ 0.819) for neonatal survival. CONCLUSION In patients with congenital diaphragmatic hernia, the relation between observed and expected MRI fetal lung volume is a valuable prognostic parameter for predicting neonatal mortality, morbidity represented by the development of chronic lung disease, and the need for ECMO therapy in early gestation (< 28 weeks) as well as later gestation with no statistically significant differences.
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Kehl S, Becker L, Eckert S, Weiss C, Schaible T, Neff KW, Siemer J, Sütterlin M. Prediction of mortality and the need for neonatal extracorporeal membrane oxygenation therapy by 3-dimensional sonography and magnetic resonance imaging in fetuses with congenital diaphragmatic hernias. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2013; 32:981-988. [PMID: 23716519 DOI: 10.7863/ultra.32.6.981] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVES To compare different rotation angles for assessment of fetal lung volume by 3-dimensional (3D) sonography with magnetic resonance imaging (MRI) regarding prediction of mortality and the need for neonatal extracorporeal membrane oxygenation (ECMO) therapy in fetuses with congenital diaphragmatic hernias. METHODS One hundred patients with fetal congenital diaphragmatic hernias between 22 and 39 weeks' gestation were examined by 3D sonography and MRI. Sonographic contralateral fetal lung volumes were assessed by the rotational technique (virtual organ computer-aided analysis) at 3 different rotation angles: 6°, 15°, and 30°. The MRI fetal lung volumes were calculated based on multiplanar T2-weighted MRI. To eliminate the influence of gestational age, the observed to expected contralateral fetal lung volume on sonography and the observed to expected fetal lung volume on MRI were calculated. Receiver operating characteristic (ROC) curves were calculated for the statistical prediction of survival and need for ECMO therapy by the observed to expected contralateral fetal lung volume (sonography) and observed to expected fetal lung volume (MRI). RESULTS One hundred cases were assessed for survival and 89 for ECMO necessity (11 neonates were not eligible for ECMO). For prediction of postpartum survival and ECMO necessity, the areas under the ROC curves (AUCs) showed very similar results for MRI and 3D sonography: observed to expected fetal lung volume by MRI, 0.819 (95% confidence interval, 0.730-0.909) and 0.835 (0.748-0.922), respectively; 6° sonography, 0.765 (0.647-0.883) and 0.820 (0.734-0.905); 15° sonography, 0.784 (0.672-0.896) and 0.811 (0.719-0.903); and 30° sonography, 0.732 (0.609-0.855) and 0.772 (0.671-0.872). Comparisons between the AUCs revealed no statistical differences. CONCLUSIONS We have shown the good prognostic value of 3D sonography in fetuses with congenital diaphragmatic hernias compared with MRI, particularly when using small rotation angles. Therefore, it can be an appropriate diagnostic tool when counseling patients for congenital diaphragmatic hernias.
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Affiliation(s)
- Sven Kehl
- Department of Obstetrics and Gynecology, Mannheim University Medical Center, Mannheim, Germany.
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Zamora IJ, Cass DL, Lee TC, Welty S, Cassady CI, Mehollin-Ray AR, Fallon SC, Ruano R, Belfort MA, Olutoye OO. The presence of a hernia sac in congenital diaphragmatic hernia is associated with better fetal lung growth and outcomes. J Pediatr Surg 2013; 48:1165-71. [PMID: 23845602 DOI: 10.1016/j.jpedsurg.2013.03.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Accepted: 03/08/2013] [Indexed: 11/27/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the relationship between the presence of a hernia sac and fetal lung growth and outcomes in infants with Congenital, Diaphragmatic Hernia (CDH). METHODS The medical records of all neonates with CDH treated in our institution between 2004 and 2011 were reviewed. The presence of a hernia sac was confirmed at the time of surgical repair or at autopsy. Data were analyzed using parametric and non-parametric tests where appropriate. Multivariable regression and survival analyses were applied. RESULTS Of 148 neonates treated for CDH, 107 (72%) had isolated CDH and 30 (20%) had a hernia sac. Infants with a hernia sac had significantly lower need for ECMO, patch repair, supplemental oxygen at 30 days of life, and shorter duration of mechanical ventilation and hospital stay. Ninety-three patients had prenatal imaging. The mean observed-to-expected total fetal lung volume in the sac group was higher throughout gestation. Although a greater percentage of sac patients had liver herniation as a dichotomous variable, the amount of herniated liver (%LH and LiTR) was significantly lower in the presence of a hernia sac. CONCLUSION The presence of a hernia sac in Congenital Diaphragmatic Hernia is associated with less visceral herniation, greater fetal lung growth, and better post-natal outcomes.
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Affiliation(s)
- Irving J Zamora
- Texas Children's Fetal Center, Texas Children's Hospital, Houston, TX 77030, USA
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34
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Debus A, Hagelstein C, Kilian AK, Weiss C, Schönberg SO, Schaible T, Neff KW, Büsing KA. Fetal Lung Volume in Congenital Diaphragmatic Hernia: Association of Prenatal MR Imaging Findings with Postnatal Chronic Lung Disease. Radiology 2013; 266:887-95. [DOI: 10.1148/radiol.12111512] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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35
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Victoria T, Danzer E, Adzick NS. Use of ultrasound and MRI for evaluation of lung volumes in fetuses with isolated left congenital diaphragmatic hernia. Semin Pediatr Surg 2013; 22:30-6. [PMID: 23395143 DOI: 10.1053/j.sempedsurg.2012.10.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Congenital diaphragmatic hernia (CDH) is an anomaly that results in lung hypoplasia and pulmonary hypertension. The lungs of the CDH fetus have an abnormal architecture, with fewer bronchial branches and decreased number of arteries and veins, factors which result in pulmonary compromise postnatally. The goal of this review is to evaluate prenatal prognostic factors in the fetus with isolated left CDH, with particular emphasis on fetal MRI. These imaging indicators may be used to provide health professionals and the parents with the most accurate information about fetal prognosis.
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Affiliation(s)
- Teresa Victoria
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19103, USA.
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36
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Liver-to-thoracic volume ratio: use at MR imaging to predict postnatal survival in fetuses with isolated congenital diaphragmatic hernia with or without prenatal tracheal occlusion. Eur Radiol 2012; 23:1299-305. [DOI: 10.1007/s00330-012-2709-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Revised: 09/30/2012] [Accepted: 10/13/2012] [Indexed: 11/26/2022]
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37
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Mehollin-Ray AR, Cassady CI, Cass DL, Olutoye OO. Fetal MR Imaging of Congenital Diaphragmatic Hernia. Radiographics 2012; 32:1067-84. [DOI: 10.1148/rg.324115155] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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38
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Quantitative pulmonary perfusion imaging at 3.0 T of 2-year-old children after congenital diaphragmatic hernia repair: initial results. Eur Radiol 2012; 22:2743-9. [PMID: 22692394 DOI: 10.1007/s00330-012-2528-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Revised: 04/26/2012] [Accepted: 05/03/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To investigate whether dynamic contrast-enhanced MR imaging of the lung following congenital diaphragmatic hernia repair is feasible at 3.0 T in 2-year-old children and whether associated lung hypoplasia (reflected in reduced pulmonary microcirculation) can be demonstrated in MRI. METHODS Twelve children with a mean age 2.0 ± 0.2 years after hernia repair underwent DCE-MRI at 3.0 T using a time-resolved angiography with stochastic trajectories sequence. Quantification of lung perfusion was performed using a pixel-by-pixel deconvolution approach. Six regions of interest were placed (upper, middle and lower parts of right and left lung) to assess differences in pulmonary blood flow (PBF), pulmonary blood volume (PBV) and mean transit time (MTT) while avoiding the inclusion of larger pulmonary arteries and veins. RESULTS The difference in PBF and PBV between ipsilateral and contralateral lung was significant (P < 0.5). No significant differences could be detected for the MTT (P = 0.5). CONCLUSION DCE-MRI in 2-year-old patients is feasible at 3.0 T. Reduced perfusion in the ipsilateral lung is reflected by significantly lower PBF values compared with the contralateral lung. DCE-MRI of the lung in congenital diaphragmatic hernia can help to characterise lung hypoplasia initially and in the long-term follow-up of children after diaphragmatic repair. KEY POINTS Congenital diaphragmatic hernia often leads to lung hypoplasia and secondary pulmonary hypertension. Dynamic contrast-enhanced 3-T magnetic resonance can assess these complications in 2-year-olds. The affected ipsilateral lung shows reduced perfusion and lower pulmonary blood flow. Thoracic DCE-MRI helps characterise lung hypoplasia in children after hernia repair.
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39
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Victoria T, Bebbington MW, Danzer E, Flake AW, Johnson MP, Dinan D, Adzick NS, Hedrick HL. Use of magnetic resonance imaging in prenatal prognosis of the fetus with isolated left congenital diaphragmatic hernia. Prenat Diagn 2012; 32:715-23. [DOI: 10.1002/pd.3890] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Teresa Victoria
- Center for Fetal Diagnosis and Treatment; The Children's Hospital of Philadelphia; Philadelphia; PA; 19103; USA
| | - Michael W. Bebbington
- Center for Fetal Diagnosis and Treatment; The Children's Hospital of Philadelphia; Philadelphia; PA; 19103; USA
| | - Enrico Danzer
- Center for Fetal Diagnosis and Treatment; The Children's Hospital of Philadelphia; Philadelphia; PA; 19103; USA
| | - Alan W. Flake
- Center for Fetal Diagnosis and Treatment; The Children's Hospital of Philadelphia; Philadelphia; PA; 19103; USA
| | - Mark P. Johnson
- Center for Fetal Diagnosis and Treatment; The Children's Hospital of Philadelphia; Philadelphia; PA; 19103; USA
| | - David Dinan
- Center for Fetal Diagnosis and Treatment; The Children's Hospital of Philadelphia; Philadelphia; PA; 19103; USA
| | - N. Scott Adzick
- Center for Fetal Diagnosis and Treatment; The Children's Hospital of Philadelphia; Philadelphia; PA; 19103; USA
| | - Holly L. Hedrick
- Center for Fetal Diagnosis and Treatment; The Children's Hospital of Philadelphia; Philadelphia; PA; 19103; USA
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40
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Le LD, Keswani SG, Biesiada J, Lim FY, Kingma PS, Haberman BE, Frischer J, Habli M, Crombleholme TM. The congenital diaphragmatic hernia composite prognostic index correlates with survival in left-sided congenital diaphragmatic hernia. J Pediatr Surg 2012; 47:57-62. [PMID: 22244393 PMCID: PMC3870853 DOI: 10.1016/j.jpedsurg.2011.10.020] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2011] [Accepted: 10/06/2011] [Indexed: 11/26/2022]
Abstract
PURPOSE We developed the congenital diaphragmatic hernia congenital prognostic index (CDH-CPI) to incorporate all known prognostic variables into a single composite index to improve prognostic accuracy. The purpose of this study is to examine the ability of the CDH-CPI to predict survival in patients with left-sided congenital diaphragmatic hernia and to determine if the index has a stronger correlation with survival than each of the individual components. METHODS A retrospective review of patients with left-sided congenital diaphragmatic hernia between 2004 and 2010 was conducted. Ten prenatal parameters of the CDH-CPI were collected, total score was tabulated, and patients stratified according to total score and survival. RESULTS Sixty-four patients with a prenatal diagnosis of left-sided congenital diaphragmatic hernia were identified. Patients with a CDH-CPI score of 8 or higher had a significantly higher survival than patients with a CDH-CPI score of lower than 8. The CDH-CPI has the strongest correlation with survival compared with the individual parameters measured. The CDH-CPI correlates with extracorporeal membrane oxygenation use, and 75% of patients with a score of 5 or lower were placed on extracorporeal membrane oxygenation. CONCLUSIONS The CDH-CPI accurately stratifies survival in left-sided congenital diaphragmatic hernia. The amalgamation of 10 prenatal parameters of the CDH-CPI may be a better prenatal predictor than any single prognostic variable currently used.
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Affiliation(s)
- Louis D. Le
- The Fetal Care Center of Cincinnati, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio 45267, USA,Division of Pediatric General, Thoracic and Fetal Surgery, The Fetal Care Center of Cincinnati, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio 45267, USA
| | - Sundeep G. Keswani
- The Fetal Care Center of Cincinnati, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio 45267, USA,Division of Pediatric General, Thoracic and Fetal Surgery, The Fetal Care Center of Cincinnati, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio 45267, USA
| | - Jacek Biesiada
- Division of Biomedical Informatics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio 45267, USA
| | - Foong-Yen Lim
- The Fetal Care Center of Cincinnati, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio 45267, USA,Division of Pediatric General, Thoracic and Fetal Surgery, The Fetal Care Center of Cincinnati, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio 45267, USA
| | - Paul S. Kingma
- Section of Neonatology, Perinatal and Pulmonary Biology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio 45229, USA
| | - Beth E. Haberman
- Section of Neonatology, Perinatal and Pulmonary Biology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio 45229, USA
| | - Jason Frischer
- Division of Pediatric General, Thoracic and Fetal Surgery, The Fetal Care Center of Cincinnati, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio 45267, USA
| | - Mounira Habli
- The Fetal Care Center of Cincinnati, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio 45267, USA,Division of Pediatric General, Thoracic and Fetal Surgery, The Fetal Care Center of Cincinnati, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio 45267, USA
| | - Timothy M. Crombleholme
- The Fetal Care Center of Cincinnati, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio 45267, USA,Division of Pediatric General, Thoracic and Fetal Surgery, The Fetal Care Center of Cincinnati, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio 45267, USA,Colorado Fetal Care Center, Colorado Institute for Maternal Fetal Health, Children’s Hospital, Colorado and the University of Colorado School of Medicine, Aurora, CO 80045, USA,Corresponding author. Division of General, Thoracic and Fetal Surgery, The Fetal Care Center of Cincinnati, Cincinnati Children’s Hospital Medical Center, MLC 11025 Cincinnati, Ohio 45229-3039, USA. Tel.: +1 513 636 6259; fax: +1 513 636 2735. (T.M. Crombleholme)
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Right- versus left-sided congenital diaphragmatic hernia: postnatal outcome at a specialized tertiary care center. Pediatr Crit Care Med 2012; 13:66-71. [PMID: 21478793 DOI: 10.1097/pcc.0b013e3182192aa9] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To systematically investigate the impact of the location of the defect in congenital diaphragmatic hernia on neonatal mortality and morbidity with a special focus on survival at discharge, extracorporeal membrane oxygenation requirement, and the development of chronic lung disease. DESIGN Retrospective tertiary care center study with a matched-pair analysis of all fetuses that were treated for congenital diaphragmatic hernia between 2004 and 2009. SETTING A specialized tertiary care center for fetuses with congenital diaphragmatic hernia. PATIENTS Complete sets of data were available for 106 patients with congenital diaphragmatic hernia. For 17 of 18 infants with right-sided congenital diaphragmatic hernia we were able to allocate infants with left-sided congenital diaphragmatic hernia with no relevant difference in previously described prognostic factors, such as pulmonary hypoplasia and liver herniation. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS There was a strong trend toward better survival in infants with right-sided congenital diaphragmatic hernia than with left-sided congenital diaphragmatic hernia (94% vs. 70%; p = .07). More neonates with left-sided congenital diaphragmatic hernia died of severe pulmonary hypertension despite extracorporeal membrane oxygenation. Fewer neonates with right-sided congenital diaphragmatic hernia died, yet higher degrees of pulmonary hypoplasia and oxygen requirement were observed despite extracorporeal membrane oxygenation. CONCLUSIONS In congenital diaphragmatic hernia, the location of the defect has a substantial impact on postnatal survival and the development of chronic lung disease. In left-sided congenital diaphragmatic hernia, pulmonary hypertension resistant to therapeutic management, including extracorporeal membrane oxygenation, is more common and is associated with a higher rate of neonatal demise. Right-sided congenital diaphragmatic hernia infants have an increased benefit from extracorporeal membrane oxygenation but the better survival entails a higher rate of chronic lung disease.
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Mayer S, Klaritsch P, Petersen S, Done E, Sandaite I, Till H, Claus F, Deprest JA. The correlation between lung volume and liver herniation measurements by fetal MRI in isolated congenital diaphragmatic hernia: a systematic review and meta-analysis of observational studies. Prenat Diagn 2011; 31:1086-96. [DOI: 10.1002/pd.2839] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2011] [Revised: 06/28/2011] [Accepted: 06/29/2011] [Indexed: 11/06/2022]
Affiliation(s)
| | - Philipp Klaritsch
- Centre for Surgical Technologies, Faculty of Medicine; Katholieke Universiteit Leuven; B-3000; Leuven; Belgium
| | - Scott Petersen
- Centre for Surgical Technologies, Faculty of Medicine; Katholieke Universiteit Leuven; B-3000; Leuven; Belgium
| | | | | | - Holger Till
- Department of Paediatric Surgery; University Hospital Leipzig; D-40103; Leipzig; Germany
| | - Filip Claus
- Department of Radiology, Division of Medical Imaging; Katholieke Universiteit Leuven; B-3000; Leuven; Belgium
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Kehl S, Zirulnik A, Debus A, Sütterlin M, Siemer J, Neff W. In vitro models of the fetal lung: comparison of lung volume measurements with 3-dimensional sonography and magnetic resonance imaging. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2011; 30:1085-1091. [PMID: 21795484 DOI: 10.7863/jum.2011.30.8.1085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVES Three-dimensional (3D) sonography is an established volumetric method in gynecology and obstetrics. The aim of this study was to investigate the variability of 3D sonographic measurements and their accuracy in comparison with magnetic resonance imaging (MRI) for assessing fetal lung volume using in vitro lung models. METHODS Twenty-three in vitro lung models with randomly defined volumes ranging from 1 to 60 mL were made from gelatin with plastic sheaths, manually molded into the shape of fetal lungs. The models were measured using 3D sonography and MRI. The 3D sonographic volumes were calculated using the rotational technique with angles of 6° and 30°. Multiplanar T2-weighted sequences were used for the MRI measurements. The percentage error and absolute percentage error were calculated for each method, and intraobserver and interobserver variability in 3D sonographic measurements was assessed with intraclass correlation coefficients (ICCs). Agreement between calculated and real volumes using the limits of agreement method was also evaluated. RESULTS The ICCs for the rotation angles indicated very good intraobserver and interobserver variability (6°, 0.995 and 0.996; 30°, 0.997 and 0.985). No systematic errors were observed in the mean percentage errors for 3D sonographic measurements or MRI volumetry. The lowest median absolute percentage error (1.76) was obtained with MRI volumetry, significantly lower than the values for sonography (6°, 5.00; P < .001; 30°, 5.49; P < .001). There were no significant differences in absolute percentage errors between the rotation angles (P = .82) and no significant differences in limits of agreement between 3D sonography and MRI (6°, P = .76; 30°, P = .39). CONCLUSIONS Three-dimensional sonographic volumetry was almost as accurate as MRI in this in vitro model and can be regarded as a good alternative method. Further research is needed to confirm these findings in vivo and to assess the prognostic value in fetuses with lung hypoplasia (eg, congenital diaphragmatic hernias).
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Affiliation(s)
- Sven Kehl
- Department of Obstetrics and Gynecology, Mannheim University Hospital, Mannheim, Germany.
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Alfaraj MA, Shah PS, Bohn D, Pantazi S, O'Brien K, Chiu PP, Gaiteiro R, Ryan G. Congenital diaphragmatic hernia: lung-to-head ratio and lung volume for prediction of outcome. Am J Obstet Gynecol 2011; 205:43.e1-8. [PMID: 21529758 DOI: 10.1016/j.ajog.2011.02.050] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2010] [Revised: 12/02/2010] [Accepted: 02/14/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate observed/expected (O/E) lung-to-head ratio (LHR) by ultrasound (US) and total fetal lung volume (TFLV) by magnetic resonance imaging as neonatal outcome predictors in isolated fetal congenital diaphragmatic hernia (CDH). STUDY DESIGN We conducted a retrospective study of 72 fetuses with isolated CDH, in whom O/E LHR and TFLV were evaluated as survival predictors. RESULTS O/E LHR on US and O/E TFLV by magnetic resonance imaging were significantly lower in newborn infants with isolated CDH who died compared with survivors (30.3 ± 8.3 vs 44.2 ± 14.2; P < .0001 for O/E LHR; 21.9 ± 6.3 vs 41.5 ± 17.6; P = .001 for O/E TFLV). Area under receiver-operator characteristics curve for survival for O/E LHR was 0.80 (95% confidence interval, 0.70-0.90). On multivariate analysis, O/E LHR predicted survival, whereas hernia side and first neonatal pH did not. For each unit increase in O/E LHR, mortality odds decreased by 11% (95% confidence interval, 4-17%). CONCLUSION In fetuses with isolated CDH, O/E LHR (US) independently predicts survival and may predict severity, allowing management to be optimized.
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Lee TC, Lim FY, Keswani SG, Frischer JS, Haberman B, Kingma PS, Habli M, Jaekle RK, Sharp G, Kline-Fath B, Rubio EI, Calvo M, Guimaraes C, Crombleholme TM. Late gestation fetal magnetic resonance imaging-derived total lung volume predicts postnatal survival and need for extracorporeal membrane oxygenation support in isolated congenital diaphragmatic hernia. J Pediatr Surg 2011; 46:1165-71. [PMID: 21683216 PMCID: PMC3870885 DOI: 10.1016/j.jpedsurg.2011.03.046] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2011] [Accepted: 03/26/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE Magnetic resonance imaging (MRI) has been used as an imaging modality to assess pulmonary hypoplasia in congenital diaphragmatic hernias (CDHs). The objective of this study was to determine if there is a correlation between late gestational fetal MRI-derived total lung volumes (TLVs) and CDH outcomes. METHODS From 2006 to 2009, 44 patients met criteria of an isolated CDH with a late gestational MRI evaluation. The prenatal TLV (in milliliters) was obtained between 32 and 34 weeks gestation. The measured study outcomes included survival, need for extracorporeal membrane oxygenation (ECMO), and length of stay. RESULTS There were 39 left and 5 right CDH patients. The average TLV was significantly lower for nonsurvivors (P = .01), and there was a significant association between lower TLV and the need for ECMO (P = .0001). When stratified by TLV, patients with a TLV of greater than 40 mL had a 90% survival vs 35% survival for a TLV of less than 20 mL. Furthermore, patients with a TLV greater than 40 mL had a lower rate of ECMO use (10%) than patients with a TLV of less than 20 mL (86%). Shorter length of stay was found to correlate with increasing TLV (P = .022). CONCLUSION Late gestation fetal MRI-derived TLV significantly correlates with postnatal survival and need for ECMO. Fetal MRI may be useful for the evaluation of patients who present late in gestation with a CDH.
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Affiliation(s)
- Timothy C. Lee
- The CDH Team, Division of Pediatric General, Thoracic and Fetal Surgery, Cincinnati Children's Hospital, Cincinnati, OH 45229-3039, USA
| | - Foong Y. Lim
- The CDH Team, Division of Pediatric General, Thoracic and Fetal Surgery, Cincinnati Children's Hospital, Cincinnati, OH 45229-3039, USA
| | - Sundeep G. Keswani
- The CDH Team, Division of Pediatric General, Thoracic and Fetal Surgery, Cincinnati Children's Hospital, Cincinnati, OH 45229-3039, USA
| | - Jason S. Frischer
- The CDH Team, Division of Pediatric General, Thoracic and Fetal Surgery, Cincinnati Children's Hospital, Cincinnati, OH 45229-3039, USA
| | - Beth Haberman
- Division of Neonatology, Cincinnati Children's Hospital, Cincinnati, OH 45229-3039, USA
| | - Paul S. Kingma
- Division of Neonatology, Cincinnati Children's Hospital, Cincinnati, OH 45229-3039, USA
| | - Mounira Habli
- Divisions of Maternal-Fetal Medicine, Good Samaritan Hospital and University Hospital, Cincinnati, OH 45229-3039, USA
| | - Ronald K. Jaekle
- Department of Obstetrics and Gynecology, University of Cincinnati, Cincinnati, OH 45229-3039, USA
| | - Gina Sharp
- The CDH Team, Division of Pediatric General, Thoracic and Fetal Surgery, Cincinnati Children's Hospital, Cincinnati, OH 45229-3039, USA
| | - Beth Kline-Fath
- Division of Radiology, Cincinnati Children's Hospital, Cincinnati, OH 45229-3039, USA
| | - Eva I. Rubio
- Division of Radiology, Cincinnati Children's Hospital, Cincinnati, OH 45229-3039, USA
| | - Maria Calvo
- Division of Radiology, Cincinnati Children's Hospital, Cincinnati, OH 45229-3039, USA
| | - Carolina Guimaraes
- Division of Radiology, Cincinnati Children's Hospital, Cincinnati, OH 45229-3039, USA
| | - Timothy M. Crombleholme
- The CDH Team, Division of Pediatric General, Thoracic and Fetal Surgery, Cincinnati Children's Hospital, Cincinnati, OH 45229-3039, USA,Corresponding author. The Fetal Care Center of Cincinnati, Division of Pediatric General, Thoracic, and Fetal Surgery, Cincinnati Children’s Hospital, Cincinnati, OH 45229-3039, USA. Tel.: +1 513 636 6259; fax: +1 513 636 5959. (T.M. Crombleholme)
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Ruano R, Aubry MCÃ, Barthe B, Dumez Y, Benachi A. Three-dimensional ultrasonographic measurements of the fetal lungs for prediction of perinatal outcome in isolated congenital diaphragmatic hernia. J Obstet Gynaecol Res 2009; 35:1031-41. [DOI: 10.1111/j.1447-0756.2009.001060.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Balassy C, Kasprian G, Brugger PC, Weber M, Csapo B, Herold C, Prayer D. Assessment of lung development in isolated congenital diaphragmatic hernia using signal intensity ratios on fetal MR imaging. Eur Radiol 2009; 20:829-37. [DOI: 10.1007/s00330-009-1633-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2009] [Revised: 08/07/2009] [Accepted: 08/26/2009] [Indexed: 11/29/2022]
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van den Hout L, Sluiter I, Gischler S, De Klein A, Rottier R, Ijsselstijn H, Reiss I, Tibboel D. Can we improve outcome of congenital diaphragmatic hernia? Pediatr Surg Int 2009; 25:733-43. [PMID: 19669650 PMCID: PMC2734260 DOI: 10.1007/s00383-009-2425-8] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
This review gives an overview of the disease spectrum of congenital diaphragmatic hernia (CDH). Etiological factors, prenatal predictors of survival, new treatment strategies and long-term morbidity are described. Early recognition of problems and improvement of treatment strategies in CDH patients may increase survival and prevent secondary morbidity. Multidisciplinary healthcare is necessary to improve healthcare for CDH patients. Absence of international therapy guidelines, lack of evidence of many therapeutic modalities and the relative low number of CDH patients calls for cooperation between centers with an expertise in the treatment of CDH patients. The international CDH Euro-Consortium is an example of such a collaborative network, which enhances exchange of knowledge, future research and development of treatment protocols.
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Affiliation(s)
- L. van den Hout
- Department of Paediatric Surgery, ErasmusMC-Sophia, Rotterdam, The Netherlands
| | - I. Sluiter
- Department of Paediatric Surgery, ErasmusMC-Sophia, Rotterdam, The Netherlands
| | - S. Gischler
- Department of Paediatric Surgery, ErasmusMC-Sophia, Rotterdam, The Netherlands
| | - A. De Klein
- Department of Genetics, ErasmusMC-Sophia, Rotterdam, The Netherlands
| | - R. Rottier
- Department of Paediatric Surgery, ErasmusMC-Sophia, Rotterdam, The Netherlands
| | - H. Ijsselstijn
- Department of Paediatric Surgery, ErasmusMC-Sophia, Rotterdam, The Netherlands
| | - I. Reiss
- Department of Paediatric Surgery, ErasmusMC-Sophia, Rotterdam, The Netherlands
| | - D. Tibboel
- Department of Paediatric Surgery, ErasmusMC-Sophia, Rotterdam, The Netherlands
- ErasmusMC-Sophia, Room SK-3284, P.O. Box 2060, 3000CB Rotterdam, The Netherlands
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Nishie A, Tajima T, Asayama Y, Ishigami K, Hirakawa M, Nakayama T, Ushijima Y, Kakihara D, Okamoto D, Yoshiura T, Masumoto K, Taguchi T, Tsukimori K, Tokunaga S, Irie H, Yoshimitsu K, Honda H. MR prediction of postnatal outcomes in left-sided congenital diaphragmatic hernia using right lung signal intensity: Comparison with that using right lung volume. J Magn Reson Imaging 2009; 30:112-20. [DOI: 10.1002/jmri.21829] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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