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Abstract
OBJECTIVE We have previously described a gestational age-independent sonographic parameter to assess fetal lung growth in the right lung (right quantitative lung index, or QLI-R). The purpose of this study was to develop a similar sonographic parameter to assess the growth of the left lung in the fetus, independent of gestational age, or QLI-L. STUDY DESIGN A new index, the QLI-L was derived using published formulas for the head circumference (HC) and the area of the base of the left lung (LA), with the corresponding percentiles. RESULTS Left lung growth can be expressed using the following formula: QLI-L=LAL(HC12)2. The 50th percentile of the QLI-L remained approximately constant at 1.0 for the GA between 16-32 weeks. A small left lung (<1st percentile) was defined as a QLI-L < 0.5. CONCLUSIONS Fetal left lung growth can be adequately described independent of gestational age using the QLI-L. Further experience is needed to assess the clinical accuracy of the QLI-L in characterizing fetal left lung growth.
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Affiliation(s)
| | | | - Ramen Chmait
- The USFetus Research Consortium, Miami, FL, USA.,Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Novoa Y Novoa VA, Sutton LF, Neis AE, Marroquin AM, Freimund TA, Coleman TM, Praska KA, Ruka KL, Warzala VL, Sangi-Haghpeykar H, Ruano R. Reproducibility of Lung-to-Head Ratio Ultrasound Measurements in Congenital Diaphragmatic Hernia. J Ultrasound Med 2018; 37:2037-2041. [PMID: 29399860 DOI: 10.1002/jum.14557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Revised: 11/17/2017] [Accepted: 11/18/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES This study investigated the reproducibility of standardization of lung-to-head ratio measurements in congenital diaphragmatic hernia (CDH) at our center among sonographers after we standardized the method. METHODS We reviewed ultrasound images of 12 fetuses with CDH at Mayo Clinic from 2010 to 2016. Nine operators (1 maternal-fetal medicine specialist with experience in measuring the lung-to-head ratio and 8 sonographers), who were blinded to previous findings, reviewed 33 selected images from 12 fetuses with left CDH. The method for lung-to-head ratio measurement was standardized before starting the measurements. The lung-to-head ratio was assessed by different methods to obtain the lung areas: anteroposterior, longest, and area tracing. We evaluated the correlation between operators using the intraclass correlation coefficient (ICC). We also compared agreement between the sonographers and a physician with experience in measuring the lung-to-head ratio using a Bland-Altman analysis. RESULTS The methods with the best interoperator reproducibility were the standardized anteroposterior lung-to-head ratio (ICC, 0.69) and the standardized lung-to-head ratio tracing (ICC, 0.65) compared to the longest lung-to-head ratio (ICC, 0.56). The standardized lung-to-head ratio tracing had the best agreement among sonographers and the physician (bias, 0.11; limits of agreement, -0.27 to +0.49) than the anteroposterior lung-to-head ratio (bias, 0.35; limits of agreement, -0.13 to + 0.83) and the longest lung-to-head ratio (bias, 0.27; limits of agreement, -0.35 to +0.89). CONCLUSIONS We demonstrated that the lung-to-head ratio tracing method has high interoperator reproducibility and the best agreement among the operators at our center. Further multicenter studies are necessary to confirm our results.
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Affiliation(s)
- Victoria Arruga Novoa Y Novoa
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Laura F Sutton
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Allan E Neis
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Amber M Marroquin
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Tamara A Freimund
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Tracey M Coleman
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Kathleen A Praska
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Krystal L Ruka
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Vicki L Warzala
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Haleh Sangi-Haghpeykar
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Rodrigo Ruano
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
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Volpe N, Mazzone E, Muto B, Suprani A, Fanelli T, Kaihura CT, Dall'Asta A, Pedrazzi G, Del Rossi C, Silini EM, Magnani C, Volpe P, Ghi T, Frusca T. Three-dimensional assessment of umbilical vein deviation angle for prediction of liver herniation in left-sided congenital diaphragmatic hernia. Ultrasound Obstet Gynecol 2018; 51:214-218. [PMID: 28078737 DOI: 10.1002/uog.17406] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 01/05/2017] [Accepted: 01/08/2017] [Indexed: 06/06/2023]
Abstract
OBJECTIVES To introduce a new sonographic marker of intrathoracic liver herniation in fetuses with left-sided congenital diaphragmatic hernia (CDH). METHODS In a consecutive series of fetuses with isolated CDH, an ultrasound volume of the fetal abdomen was acquired. On this volume, offline calculation of the angle formed by the midline of the abdomen (joining the center of the vertebral body to the abdominal insertion of the umbilical cord) and a second line joining the center of the vertebral body to the intra-abdominal convexity of the umbilical vein was carried out to give the umbilical vein deviation angle (UVDA). The UVDA was measured in a group of normal fetuses selected as controls. At follow-up, the presence of liver herniation was investigated in all cases of CDH. UVDA values were compared between the CDH group and controls, and between CDH 'liver-up' vs 'liver-down' cases. A receiver-operating characteristics (ROC) curve was constructed to identify a cut-off value of the UVDA with the highest accuracy in predicting liver herniation in the CDH group. RESULTS Between 2009 and 2015, 22 cases of left-sided CDH were included in the study group, of which nine cases had liver herniation. Eighty-eight normal fetuses were recruited as controls. The UVDA was significantly higher in the cases vs controls (15.25 ± 7.91° vs 7.68 ± 1.55°; P < 0.0001). Moreover, the UVDA was significantly increased in CDH fetuses with liver-up vs liver-down (21.77 ± 8.79° vs 10.75 ± 2.10°; P < 0.0001). On ROC curve analysis the UVDA showed good prediction of liver herniation (area under the ROC curve, 0.94; P < 0.0001) with the best cut-off of 15.2°, yielding a sensitivity of 89% and a specificity of 100% (P < 0.0001). CONCLUSIONS In fetuses with CDH, umbilical vein bowing may be quantified by measuring the UVDA using three-dimensional ultrasound. This sonographic marker seems to be an accurate predictor of liver herniation in left-sided CDH. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- N Volpe
- Obstetrics and Gynecology Unit, Department of Medicine and Surgery, Unit of Surgical Sciences, Maggiore Hospital, University of Parma, Parma, Italy
| | - E Mazzone
- Obstetrics and Gynecology Unit, Department of Medicine and Surgery, Unit of Surgical Sciences, Maggiore Hospital, University of Parma, Parma, Italy
| | - B Muto
- Fetal Medicine Unit, Di Venere and Sarcone Hospitals, ASL BA, Bari, Italy
| | - A Suprani
- Obstetrics and Gynecology Unit, Department of Medicine and Surgery, Unit of Surgical Sciences, Maggiore Hospital, University of Parma, Parma, Italy
| | - T Fanelli
- Fetal Medicine Unit, Di Venere and Sarcone Hospitals, ASL BA, Bari, Italy
| | - C T Kaihura
- Obstetrics and Gynecology Unit, Department of Medicine and Surgery, Unit of Surgical Sciences, Maggiore Hospital, University of Parma, Parma, Italy
| | - A Dall'Asta
- Obstetrics and Gynecology Unit, Department of Medicine and Surgery, Unit of Surgical Sciences, Maggiore Hospital, University of Parma, Parma, Italy
| | - G Pedrazzi
- Department of Neuroscience, University of Parma, Parma, Italy
| | - C Del Rossi
- Paediatric Hospital 'P. Barilla', Paediatric Surgery Unit, University of Parma, Parma, Italy
| | - E M Silini
- Department of Biomedical, Biotechnological and Translational Sciences, Pathological Anatomy and Histology Unit, University of Parma, Parma, Italy
| | - C Magnani
- Paediatric Hospital 'P. Barilla', Neonatology Unit, University of Parma, Parma, Italy
| | - P Volpe
- Fetal Medicine Unit, Di Venere and Sarcone Hospitals, ASL BA, Bari, Italy
| | - T Ghi
- Obstetrics and Gynecology Unit, Department of Medicine and Surgery, Unit of Surgical Sciences, Maggiore Hospital, University of Parma, Parma, Italy
| | - T Frusca
- Obstetrics and Gynecology Unit, Department of Medicine and Surgery, Unit of Surgical Sciences, Maggiore Hospital, University of Parma, Parma, Italy
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Senat MV, Bouchghoul H, Stirnemann J, Vaast P, Boubnova J, Begue L, Carricaburu E, Sartor A, Jani J, Benachi A, Bouyer J. Prognosis of isolated congenital diaphragmatic hernia using lung-area-to-head-circumference ratio: variability across centers in a national perinatal network. Ultrasound Obstet Gynecol 2018; 51:208-213. [PMID: 28295742 DOI: 10.1002/uog.17463] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 02/20/2017] [Accepted: 03/03/2017] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Congenital diaphragmatic hernia (CDH) is a severe anomaly. The observed-to-expected lung-area-to-head-circumference ratio (o/e-LHR) has been shown to provide a useful prediction of subsequent survival of fetuses with CDH in referral centers with expertise and a large caseload. However, the accuracy of o/e-LHR measurements in general fetal medicine units with less expertise is not well known. The aim of this study was to evaluate the capacity of o/e-LHR to provide a useful prediction of mortality of fetuses with CDH when the measurement is performed in fetal medicine units with different levels of expertise. METHODS Between January 2008 and November 2013, 305 live births with expectantly managed left-sided isolated CDH were recorded in the database of the French National Center for Rare Diseases (31 centers) and followed up after birth. Centers were grouped into two categories according to their mean annual CDH caseload over the study period: large centers with an average of ≥ 14 cases and smaller centers with < 14 cases per year. The relationship between o/e-LHR and 28-day and 6-month mortality was modeled using fractional polynomials and the predictive value of o/e-LHR was quantified using the area under the receiver-operating characteristics curve. Comparisons between the two center categories were carried out. Analyses were adjusted for potential confounders such as thoracic herniation of the liver and gestational age at birth and at diagnosis. RESULTS During the study period, two large centers managed a total of 82 CDH cases and 29 smaller centers a total of 223 CDH cases. Overall, there was a significant inverse relationship between 28-day mortality rate and o/e-LHR, which decreased from 54% when o/e-LHR was 20% to 6% when o/e-LHR was 75% (P < 0.01). When the category of center was considered, adjusted associations between o/e-LHR and 28-day mortality were significantly different (P = 0.032) between large and smaller centers. The ability to predict survival at 28 days postpartum based on o/e-LHR was better in large centers; for a specificity of 0.30, the sensitivity was 0.71 in large centers and 0.55 in smaller ones. The results were similar for 6-month mortality. CONCLUSIONS Our results show that o/e-LHR measured on two-dimensional ultrasound is a good indicator of neonatal prognosis in cases of CDH that may be used even in fetal medicine centers with a small caseload. However, our results also suggest that LHR measurement may be difficult to perform correctly. Therefore, appropriate training should be offered to professionals. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- M-V Senat
- Center for Research in Epidemiology and Population Health (CESP), Université Paris-Saclay, Université Paris-Sud, UVSQ, INSERM, Villejuif, France
- Centre Maladie Rare: Hernie de Coupole Diaphragmatique, Paris, France
- Department of Obstetrics and Gynecology, Hôpital Bicêtre, AP-HP, Université Paris-Sud, Le Kremlin-Bicêtre, France
| | - H Bouchghoul
- Center for Research in Epidemiology and Population Health (CESP), Université Paris-Saclay, Université Paris-Sud, UVSQ, INSERM, Villejuif, France
- Centre Maladie Rare: Hernie de Coupole Diaphragmatique, Paris, France
- Department of Obstetrics and Gynecology, Hôpital Bicêtre, AP-HP, Université Paris-Sud, Le Kremlin-Bicêtre, France
| | - J Stirnemann
- Department of Obstetrics and Maternal-Fetal Medicine, Necker-Enfants Malades Hospital, AP-HP, Paris, France
- Université Paris Descartes 5 CHU Lille, Pôle Femme Mère Nouveau-né, Lille, France
| | - P Vaast
- Centre Maladie Rare: Hernie de Coupole Diaphragmatique, Paris, France
- Université Lille, EA 4489, Environnement Périnatal et Santé, Lille, France
| | - J Boubnova
- Centre Maladie Rare: Hernie de Coupole Diaphragmatique, Paris, France
- Service de Chirurgie Pédiatrique, Hôpital de la Timone, Marseille, France
| | - L Begue
- Service de Gynécologie-Obstétrique, Centre Hospitalier Universitaire, Montpellier, France
| | - E Carricaburu
- Service de Chirurgie Pédiatrique, Hopital Robert Debré, AP-HP, Paris, France
| | - A Sartor
- Service de Gynécologie-Obstétrique Paule de Viguier Hospital, Toulouse, France
| | - J Jani
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - A Benachi
- Centre Maladie Rare: Hernie de Coupole Diaphragmatique, Paris, France
- Service de Gynécologie-Obstétrique, Hôpital Antoine Béclère, AP-HP, Paris-Sud, Paris-Saclay University, Clamart, France
| | - J Bouyer
- Center for Research in Epidemiology and Population Health (CESP), Université Paris-Saclay, Université Paris-Sud, UVSQ, INSERM, Villejuif, France
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Basta AM, Lusk LA, Keller RL, Filly RA. Spleen Behind the Heart Complicates Lung-to-Head Ratio Measurement in Left-Sided Congenital Diaphragmatic Hernia. J Ultrasound Med 2016; 35:2717-2721. [PMID: 27872422 DOI: 10.7863/ultra.15.11063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 12/23/2015] [Accepted: 02/26/2015] [Indexed: 06/06/2023]
Abstract
In fetuses with left-sided congenital diaphragmatic hernia, intrathoracic herniation of the spleen is a common occurrence. The herniated spleen can reside posterior to the left atrium of the heart in the right hemithorax and is increasingly differentiated from the lung with the use of newer sonographic equipment. Estimation of the neonatal prognosis relies on accurate measurement of fetal lung size, particularly with commonly used measurements such as the lung-to-head ratio. Here we describe how herniation of the spleen behind the heart can complicate measurement of the lung-to-head ratio on sonography and lead to overestimation, with implications for perinatal prognostication and management.
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Affiliation(s)
- Amaya M Basta
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, Medical Center, San Francisco, California USA
| | - Leslie A Lusk
- Department of Pediatrics, Division of Neonatology, University of California, San Francisco, Benioff Children's Hospital, San Francisco, California USA
| | - Roberta L Keller
- Department of Pediatrics, Division of Neonatology, University of California, San Francisco, Benioff Children's Hospital, San Francisco, California USA
- University of California, San Francisco, Fetal Treatment Center, San Francisco, California USA
| | - Roy A Filly
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, Medical Center, San Francisco, California USA
- University of California, San Francisco, Fetal Treatment Center, San Francisco, California USA
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Sananes N, Britto I, Akinkuotu AC, Olutoye OO, Cass DL, Sangi-Haghpeykar H, Lee TC, Cassady CI, Mehollin-Ray A, Welty S, Fernandes C, Belfort MA, Lee W, Ruano R. Improving the Prediction of Neonatal Outcomes in Isolated Left-Sided Congenital Diaphragmatic Hernia by Direct and Indirect Sonographic Assessment of Liver Herniation. J Ultrasound Med 2016; 35:1437-1443. [PMID: 27208195 DOI: 10.7863/ultra.15.07020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 10/14/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES Liver herniation can be assessed sonographically by either a direct (liver-to-thoracic area ratio) or an indirect (stomach position) method. Our objective was to evaluate the utility of those methods to assess liver herniation for the prediction of neonatal outcomes in patients with isolated left-sided congenital diaphragmatic hernia (CDH). METHODS We conducted a retrospective cohort study of all patients with CDH who had prenatal assessment and were delivered at Texas Children's Hospital between January 2004 and April 2014. The predictive value of sonographic parameters for mortality and the need for extracorporeal membrane oxygenation was evaluated by univariate, multivariate, and factor analysis and by receiver operating characteristics curves. RESULTS A total of 77 fetuses with isolated left-sided CDH were analyzed. The lung-to-head ratio, liver-to-thorax ratio, and stomach position (according to the classifications of Kitano et al [Ultrasound Obstet Gynecol 2011; 37:277-282] and Cordier et al [J Matern Fetal Neonatal Med 2015; 28:190-195]) were significantly associated with both neonatal outcomes (P < .03). Significant correlations were observed between all of these sonographic parameters. A combination of the liver-to-thorax ratio and stomach position (Kitano) or stomach position (Cordier) with the lung-to-head ratio increased the area under the receiver operating characteristic curve of the lung-to-head ratio for mortality prediction (0.86 [95% confidence interval, 0.74-0.98], 0.83 [0.72-0.95], and 0.83 [0.74-0.92], respectively). CONCLUSIONS Sonographic measurements of liver herniation (liver-to-thorax ratio and stomach position) are predictive of neonatal outcomes in isolated left-sided congenital diaphragmatic hernia. Our study shows that the combination of those sonographic measurements of liver herniation and lung size improves the accuracy of predicting mortality in those fetuses.
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Affiliation(s)
- Nicolas Sananes
- Department of Obstetrics and Gynecology, Texas Children's Fetal Center and Baylor College of Medicine, Houston, Texas USA
| | - Ingrid Britto
- Department of Obstetrics and Gynecology, Texas Children's Fetal Center and Baylor College of Medicine, Houston, Texas USA
| | - Adesola C Akinkuotu
- Michael E. DeBakey Department of Surgery, Texas Children's Fetal Center and Baylor College of Medicine, Houston, Texas USA
| | - Oluyinka O Olutoye
- Michael E. DeBakey Department of Surgery, Texas Children's Fetal Center and Baylor College of Medicine, Houston, Texas USA
| | - Darrell L Cass
- Michael E. DeBakey Department of Surgery, Texas Children's Fetal Center and Baylor College of Medicine, Houston, Texas USA
| | - Haleh Sangi-Haghpeykar
- Department of Obstetrics and Gynecology, Texas Children's Fetal Center and Baylor College of Medicine, Houston, Texas USA
| | - Timothy C Lee
- Michael E. DeBakey Department of Surgery, Texas Children's Fetal Center and Baylor College of Medicine, Houston, Texas USA
| | - Christopher I Cassady
- Department of Radiology, Texas Children's Fetal Center and Baylor College of Medicine, Houston, Texas USA
| | - Amy Mehollin-Ray
- Department of Radiology, Texas Children's Fetal Center and Baylor College of Medicine, Houston, Texas USA
| | - Stephen Welty
- Department of Pediatrics, Section of Neonatology, Texas Children's Fetal Center and Baylor College of Medicine, Houston, Texas USA
| | - Caraciolo Fernandes
- Department of Pediatrics, Section of Neonatology, Texas Children's Fetal Center and Baylor College of Medicine, Houston, Texas USA
| | - Michael A Belfort
- Department of Obstetrics and Gynecology, Texas Children's Fetal Center and Baylor College of Medicine, Houston, Texas USA
| | - Wesley Lee
- Department of Obstetrics and Gynecology, Texas Children's Fetal Center and Baylor College of Medicine, Houston, Texas USA
| | - Rodrigo Ruano
- Department of Obstetrics and Gynecology, Texas Children's Fetal Center and Baylor College of Medicine, Houston, Texas USA
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Kastenholz KE, Weis M, Hagelstein C, Weiss C, Kehl S, Schaible T, Neff KW. 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] [What about the content of this article? (0)] [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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8
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Sananes N, Rodo C, Peiro JL, Britto ISW, Sangi-Haghpeykar H, Favre R, Joal A, Gaudineau A, Silva MMD, Tannuri U, Zugaib M, Carreras E, Ruano R. Prematurity and fetal lung response after tracheal occlusion in fetuses with severe congenital diaphragmatic hernia. J Matern Fetal Neonatal Med 2015; 29:3030-4. [PMID: 26633729 DOI: 10.3109/14767058.2015.1114080] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To evaluate the independent association of fetal pulmonary response and prematurity to postnatal outcomes after fetal tracheal occlusion for congenital diaphragmatic hernia. METHODS Fetal pulmonary response, prematurity (<37 weeks at delivery) and extreme prematurity (<32 weeks at delivery) were evaluated and compared between survivors and non-survivors at 6 months of life. Multivariable analysis was conducted with generalized linear mixed models for variables significantly associated with survival in univariate analysis. RESULTS Eighty-four infants were included, of whom 40 survived (47.6%) and 44 died (52.4%). Univariate analysis demonstrated that survival was associated with greater lung response (p=0.006), and the absence of extreme preterm delivery (p=0.044). In multivariable analysis, greater pulmonary response after FETO was an independent predictor of survival (aOR 1.87, 95% CI 1.08-3.33, p=0.023), whereas the presence of extreme prematurity was not statistically associated with mortality after controlling for fetal pulmonary response (aOR 0.52, 95% CI 0.12-2.30, p=0.367). CONCLUSION Fetal pulmonary response after FETO is the most important factor associated with survival, independently from the gestational age at delivery.
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Affiliation(s)
- Nicolas Sananes
- a Department of Obstetrics and Gynecology , Texas Children's Fetal Center, Baylor College of Medicine , Houston , TX , USA .,b Service De Gynécologie Obstétrique, CMCO - HUS, Hôpitaux Universitaires De Strasbourg , Strasbourg , France
| | - Carlota Rodo
- c Fetal Surgery Program, Hospital Universitari Vall D'hebron , Barcelona , Spain
| | - Jose Luis Peiro
- c Fetal Surgery Program, Hospital Universitari Vall D'hebron , Barcelona , Spain
| | - Ingrid Schwach Werneck Britto
- a Department of Obstetrics and Gynecology , Texas Children's Fetal Center, Baylor College of Medicine , Houston , TX , USA
| | - Haleh Sangi-Haghpeykar
- a Department of Obstetrics and Gynecology , Texas Children's Fetal Center, Baylor College of Medicine , Houston , TX , USA
| | - Romain Favre
- b Service De Gynécologie Obstétrique, CMCO - HUS, Hôpitaux Universitaires De Strasbourg , Strasbourg , France
| | - Arnaud Joal
- b Service De Gynécologie Obstétrique, CMCO - HUS, Hôpitaux Universitaires De Strasbourg , Strasbourg , France
| | - Adrien Gaudineau
- b Service De Gynécologie Obstétrique, CMCO - HUS, Hôpitaux Universitaires De Strasbourg , Strasbourg , France
| | | | | | - Marcelo Zugaib
- e Department of Obstetrics and Gynecology , Faculdade De Medicina, Universidade De Sao Paulo , Sao Paulo , Brazil
| | - Elena Carreras
- b Service De Gynécologie Obstétrique, CMCO - HUS, Hôpitaux Universitaires De Strasbourg , Strasbourg , France
| | - Rodrigo Ruano
- a Department of Obstetrics and Gynecology , Texas Children's Fetal Center, Baylor College of Medicine , Houston , TX , USA .,e Department of Obstetrics and Gynecology , Faculdade De Medicina, Universidade De Sao Paulo , Sao Paulo , Brazil
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Britto ISW, Sananes N, Olutoye OO, Cass DL, Sangi-Haghpeykar H, Lee TC, Cassady CI, Mehollin-Ray A, Welty S, Fernandes C, Belfort MA, Lee W, Ruano R. Standardization of Sonographic Lung-to-Head Ratio Measurements in Isolated Congenital Diaphragmatic Hernia: Impact on the Reproducibility and Efficacy to Predict Outcomes. J Ultrasound Med 2015; 34:1721-1727. [PMID: 26307118 DOI: 10.7863/ultra.15.14.11064] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 12/16/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVES The purpose of this study was to evaluate the impact of standardization of the lung-to-head ratio measurements in isolated congenital diaphragmatic hernia on prediction of neonatal outcomes and reproducibility. METHODS We conducted a retrospective cohort study of 77 cases of isolated congenital diaphragmatic hernia managed in a single center between 2004 and 2012. We compared lung-to-head ratio measurements that were performed prospectively in our institution without standardization to standardized measurements performed according to a defined protocol. RESULTS The standardized lung-to-head ratio measurements were statistically more accurate than the nonstandardized measurements for predicting neonatal mortality (area under the receiver operating characteristic curve, 0.85 versus 0.732; P = .003). After standardization, there were no statistical differences in accuracy between measurements regardless of whether we considered observed-to-expected values (P > .05). Standardization of the lung-to-head ratio did not improve prediction of the need for extracorporeal membrane oxygenation (P> .05). Both intraoperator and interoperator reproducibility were good for the standardized lung-to-head ratio (intraclass correlation coefficient, 0.98 [95% confidence interval, 0.97-0.99]; bias, 0.02 [limits of agreement, -0.11 to +0.15], respectively). CONCLUSIONS Standardization of lung-to-head ratio measurements improves prediction of neonatal outcomes. Further studies are needed to confirm these results and to assess the utility of standardization of other prognostic parameters.
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Affiliation(s)
- Ingrid Schwach Werneck Britto
- Texas Children's Fetal Center, Houston, Texas USA (I.S.W.B., N.S., O.O.O., D.L.C., T.C.L., C.I.C., A.M.-R., S.W., C.F., M.A.B., W.L., R.R.); and Department of Obstetrics and Gynecology (I.S.W.B., N.S., H.S.-H., M.A.B., W.L., R.R.), Michael E. DeBakey Department of Surgery (O.O.O., D.L.C., T.C.L.), Department of Radiology (C.I.C., A.M.-R.), and Department of Pediatrics, Section of Neonatology (S.W., C.F.), Baylor College of Medicine, Houston, Texas USA
| | - Nicolas Sananes
- Texas Children's Fetal Center, Houston, Texas USA (I.S.W.B., N.S., O.O.O., D.L.C., T.C.L., C.I.C., A.M.-R., S.W., C.F., M.A.B., W.L., R.R.); and Department of Obstetrics and Gynecology (I.S.W.B., N.S., H.S.-H., M.A.B., W.L., R.R.), Michael E. DeBakey Department of Surgery (O.O.O., D.L.C., T.C.L.), Department of Radiology (C.I.C., A.M.-R.), and Department of Pediatrics, Section of Neonatology (S.W., C.F.), Baylor College of Medicine, Houston, Texas USA
| | - Oluyinka O Olutoye
- Texas Children's Fetal Center, Houston, Texas USA (I.S.W.B., N.S., O.O.O., D.L.C., T.C.L., C.I.C., A.M.-R., S.W., C.F., M.A.B., W.L., R.R.); and Department of Obstetrics and Gynecology (I.S.W.B., N.S., H.S.-H., M.A.B., W.L., R.R.), Michael E. DeBakey Department of Surgery (O.O.O., D.L.C., T.C.L.), Department of Radiology (C.I.C., A.M.-R.), and Department of Pediatrics, Section of Neonatology (S.W., C.F.), Baylor College of Medicine, Houston, Texas USA
| | - Darrell L Cass
- Texas Children's Fetal Center, Houston, Texas USA (I.S.W.B., N.S., O.O.O., D.L.C., T.C.L., C.I.C., A.M.-R., S.W., C.F., M.A.B., W.L., R.R.); and Department of Obstetrics and Gynecology (I.S.W.B., N.S., H.S.-H., M.A.B., W.L., R.R.), Michael E. DeBakey Department of Surgery (O.O.O., D.L.C., T.C.L.), Department of Radiology (C.I.C., A.M.-R.), and Department of Pediatrics, Section of Neonatology (S.W., C.F.), Baylor College of Medicine, Houston, Texas USA
| | - Haleh Sangi-Haghpeykar
- Texas Children's Fetal Center, Houston, Texas USA (I.S.W.B., N.S., O.O.O., D.L.C., T.C.L., C.I.C., A.M.-R., S.W., C.F., M.A.B., W.L., R.R.); and Department of Obstetrics and Gynecology (I.S.W.B., N.S., H.S.-H., M.A.B., W.L., R.R.), Michael E. DeBakey Department of Surgery (O.O.O., D.L.C., T.C.L.), Department of Radiology (C.I.C., A.M.-R.), and Department of Pediatrics, Section of Neonatology (S.W., C.F.), Baylor College of Medicine, Houston, Texas USA
| | - Timothy C Lee
- Texas Children's Fetal Center, Houston, Texas USA (I.S.W.B., N.S., O.O.O., D.L.C., T.C.L., C.I.C., A.M.-R., S.W., C.F., M.A.B., W.L., R.R.); and Department of Obstetrics and Gynecology (I.S.W.B., N.S., H.S.-H., M.A.B., W.L., R.R.), Michael E. DeBakey Department of Surgery (O.O.O., D.L.C., T.C.L.), Department of Radiology (C.I.C., A.M.-R.), and Department of Pediatrics, Section of Neonatology (S.W., C.F.), Baylor College of Medicine, Houston, Texas USA
| | - Christopher I Cassady
- Texas Children's Fetal Center, Houston, Texas USA (I.S.W.B., N.S., O.O.O., D.L.C., T.C.L., C.I.C., A.M.-R., S.W., C.F., M.A.B., W.L., R.R.); and Department of Obstetrics and Gynecology (I.S.W.B., N.S., H.S.-H., M.A.B., W.L., R.R.), Michael E. DeBakey Department of Surgery (O.O.O., D.L.C., T.C.L.), Department of Radiology (C.I.C., A.M.-R.), and Department of Pediatrics, Section of Neonatology (S.W., C.F.), Baylor College of Medicine, Houston, Texas USA
| | - Amy Mehollin-Ray
- Texas Children's Fetal Center, Houston, Texas USA (I.S.W.B., N.S., O.O.O., D.L.C., T.C.L., C.I.C., A.M.-R., S.W., C.F., M.A.B., W.L., R.R.); and Department of Obstetrics and Gynecology (I.S.W.B., N.S., H.S.-H., M.A.B., W.L., R.R.), Michael E. DeBakey Department of Surgery (O.O.O., D.L.C., T.C.L.), Department of Radiology (C.I.C., A.M.-R.), and Department of Pediatrics, Section of Neonatology (S.W., C.F.), Baylor College of Medicine, Houston, Texas USA
| | - Stephen Welty
- Texas Children's Fetal Center, Houston, Texas USA (I.S.W.B., N.S., O.O.O., D.L.C., T.C.L., C.I.C., A.M.-R., S.W., C.F., M.A.B., W.L., R.R.); and Department of Obstetrics and Gynecology (I.S.W.B., N.S., H.S.-H., M.A.B., W.L., R.R.), Michael E. DeBakey Department of Surgery (O.O.O., D.L.C., T.C.L.), Department of Radiology (C.I.C., A.M.-R.), and Department of Pediatrics, Section of Neonatology (S.W., C.F.), Baylor College of Medicine, Houston, Texas USA
| | - Caraciolo Fernandes
- Texas Children's Fetal Center, Houston, Texas USA (I.S.W.B., N.S., O.O.O., D.L.C., T.C.L., C.I.C., A.M.-R., S.W., C.F., M.A.B., W.L., R.R.); and Department of Obstetrics and Gynecology (I.S.W.B., N.S., H.S.-H., M.A.B., W.L., R.R.), Michael E. DeBakey Department of Surgery (O.O.O., D.L.C., T.C.L.), Department of Radiology (C.I.C., A.M.-R.), and Department of Pediatrics, Section of Neonatology (S.W., C.F.), Baylor College of Medicine, Houston, Texas USA
| | - Michael A Belfort
- Texas Children's Fetal Center, Houston, Texas USA (I.S.W.B., N.S., O.O.O., D.L.C., T.C.L., C.I.C., A.M.-R., S.W., C.F., M.A.B., W.L., R.R.); and Department of Obstetrics and Gynecology (I.S.W.B., N.S., H.S.-H., M.A.B., W.L., R.R.), Michael E. DeBakey Department of Surgery (O.O.O., D.L.C., T.C.L.), Department of Radiology (C.I.C., A.M.-R.), and Department of Pediatrics, Section of Neonatology (S.W., C.F.), Baylor College of Medicine, Houston, Texas USA
| | - Wesley Lee
- Texas Children's Fetal Center, Houston, Texas USA (I.S.W.B., N.S., O.O.O., D.L.C., T.C.L., C.I.C., A.M.-R., S.W., C.F., M.A.B., W.L., R.R.); and Department of Obstetrics and Gynecology (I.S.W.B., N.S., H.S.-H., M.A.B., W.L., R.R.), Michael E. DeBakey Department of Surgery (O.O.O., D.L.C., T.C.L.), Department of Radiology (C.I.C., A.M.-R.), and Department of Pediatrics, Section of Neonatology (S.W., C.F.), Baylor College of Medicine, Houston, Texas USA
| | - Rodrigo Ruano
- Texas Children's Fetal Center, Houston, Texas USA (I.S.W.B., N.S., O.O.O., D.L.C., T.C.L., C.I.C., A.M.-R., S.W., C.F., M.A.B., W.L., R.R.); and Department of Obstetrics and Gynecology (I.S.W.B., N.S., H.S.-H., M.A.B., W.L., R.R.), Michael E. DeBakey Department of Surgery (O.O.O., D.L.C., T.C.L.), Department of Radiology (C.I.C., A.M.-R.), and Department of Pediatrics, Section of Neonatology (S.W., C.F.), Baylor College of Medicine, Houston, Texas USA.
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10
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Werneck Britto IS, Olutoye OO, Cass DL, Zamora IJ, Lee TC, Cassady CI, Mehollin-Ray A, Welty S, Fernandes C, Belfort MA, Lee W, Ruano R. Quantification of liver herniation in fetuses with isolated congenital diaphragmatic hernia using two-dimensional ultrasonography. Ultrasound Obstet Gynecol 2015; 46:150-154. [PMID: 25366655 DOI: 10.1002/uog.14718] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Revised: 10/04/2014] [Accepted: 10/22/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVES To describe a method of quantifying the amount of liver herniation in fetuses with isolated congenital diaphragmatic hernia (CDH) using two-dimensional ultrasonography and to correlate this finding with neonatal outcome. METHODS Ultrasound images obtained from 77 consecutive fetuses that presented with isolated CDH between January 2004 and July 2012 were reviewed. Liver herniation and thoracic area were measured in a cross-sectional plane of the fetal chest at the level of the four-chamber view of the heart (the same section as is used to measure the lung area-to-head circumference ratio) and the ultrasound-derived liver-to-thoracic area ratio (US-LiTR) was calculated by dividing the liver herniation area by the thoracic area. Receiver-operating characteristics (ROC) curve analysis was used to evaluate the performance of US-LiTR in predicting neonatal outcome (survival to 6 months after delivery and need for extracorporeal membrane oxygenation (ECMO)). In addition, the US-LiTR was compared with the magnetic resonance imaging (MRI)-derived volume ratio (MRI-LiTR) and percentage of liver herniation (MRI-%LH). RESULTS The overall neonatal mortality in the 77 cases with isolated CDH was 20.8% (16/77). ECMO was needed in 35.5% (27/76) of the newborns, with a survival rate of 52%. The US-LiTR was associated statistically with mortality (P < 0.01) and with the need for ECMO (P < 0.01). Good correlations were observed between US-LiTR and MRI-LiTR (r = 0.87; P < 0.001) and between US-LiTR and MRI-%LH (r = 0.90; P < 0.001). Based on ROC curve analysis, all three parameters had similar accuracy in predicting mortality (US-LiTR: area under the ROC curve (AUC), 0.78 (95% CI, 0.65-0.92), P < 0.01; MRI-LiTR: AUC, 0.77 (95% CI, 0.63-0.90), P < 0.01; MRI-%LH: AUC, 0.79 (95% CI, 0.65-0.92), P < 0.01, respectively) as well as the need for ECMO (US-LiTR: AUC, 0.72 (95% CI, 0.60-0.84), P < 0.01; MRI-LiTR: AUC, 0.73 (95% CI, 0.60-0.88), P < 0.01; MRI-%LH: AUC, 0.77 (95% CI, 0.64-0.89), P < 0.01, respectively). CONCLUSIONS Two-dimensional ultrasound measurement of the amount of liver herniation in fetuses with isolated CDH is feasible and demonstrates a predictive accuracy for neonatal outcome similar to that of MRI.
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MESH Headings
- Adult
- Cohort Studies
- Extracorporeal Membrane Oxygenation/methods
- Female
- Fetal Diseases/diagnostic imaging
- Fetal Diseases/pathology
- Fetal Diseases/therapy
- Hernias, Diaphragmatic, Congenital/diagnostic imaging
- Hernias, Diaphragmatic, Congenital/pathology
- Hernias, Diaphragmatic, Congenital/surgery
- Hernias, Diaphragmatic, Congenital/therapy
- Humans
- Infant, Newborn
- Liver Diseases/diagnostic imaging
- Liver Diseases/embryology
- Liver Diseases/pathology
- Liver Diseases/therapy
- Magnetic Resonance Imaging/methods
- Predictive Value of Tests
- Pregnancy
- Retrospective Studies
- Ultrasonography, Prenatal/methods
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Affiliation(s)
- I S Werneck Britto
- Texas Children's Fetal Center, Houston, TX, USA
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA
| | - O O Olutoye
- Texas Children's Fetal Center, Houston, TX, USA
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - D L Cass
- Texas Children's Fetal Center, Houston, TX, USA
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - I J Zamora
- Texas Children's Fetal Center, Houston, TX, USA
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - T C Lee
- Texas Children's Fetal Center, Houston, TX, USA
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - C I Cassady
- Texas Children's Fetal Center, Houston, TX, USA
- Department of Radiology, Baylor College of Medicine, Houston, TX, USA
| | - A Mehollin-Ray
- Texas Children's Fetal Center, Houston, TX, USA
- Department of Radiology, Baylor College of Medicine, Houston, TX, USA
| | - S Welty
- Texas Children's Fetal Center, Houston, TX, USA
- Section of Neonatology, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - C Fernandes
- Texas Children's Fetal Center, Houston, TX, USA
- Section of Neonatology, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - M A Belfort
- Texas Children's Fetal Center, Houston, TX, USA
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA
| | - W Lee
- Texas Children's Fetal Center, Houston, TX, USA
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA
| | - R Ruano
- Texas Children's Fetal Center, Houston, TX, USA
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA
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11
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Lusk LA, Wai KC, Moon-Grady AJ, Basta AM, Filly R, Keller RL. Fetal ultrasound markers of severity predict resolution of pulmonary hypertension in congenital diaphragmatic hernia. Am J Obstet Gynecol 2015; 213:216.e1-8. [PMID: 25797231 PMCID: PMC4519413 DOI: 10.1016/j.ajog.2015.03.036] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 02/11/2015] [Accepted: 03/17/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Congenital diaphragmatic hernia (CDH) results in morbidity and death from lung hypoplasia and persistent pulmonary hypertension (PH). We sought to define the relationship between fetal ultrasound markers of severity in CDH and the time to resolution of neonatal PH. STUDY DESIGN We conducted a retrospective study of fetuses with an antenatal ultrasound scan and left-sided CDH cared for at the University of California San Francisco (2002-2012). Fetal liver position was classified on ultrasound scan as abdominal (entire liver within the abdomen) or thoracic (any portion of the liver within the thorax). Fetal stomach position was classified from least to most aberrant: abdominal, anterior left chest, mid-posterior left chest, or retrocardiac (right chest). Lung-to-head ratio (LHR) was determined from available scans at 20-29 weeks of gestational age (GA). Routine neonatal echocardiograms were performed weekly for up to 6 weeks or until PH resolved or until discharge. PH was assessed by echocardiogram with the use of a hierarchy of ductus arteriosus level shunt, interventricular septal position, and tricuspid regurgitant jet velocity. Days to PH-free survival was defined as the age at which pulmonary artery pressure was estimated to be <2/3 systemic blood pressure. Cox proportional hazards models adjusted for GA at birth, era of birth, fetal surgery, and GA at ultrasound scan (LHR model only), with censoring at 100 days. RESULTS Of 118 patients, the following fetal markers were available: LHR (n = 53), liver position (n = 112), and stomach position (n = 80). Fewer infants experienced resolved PH if they had LHR <1 (P = .006), thoracic liver position (P = .001), or more aberrant stomach position (P < .001). There was also a decreased rate of resolution of PH in infants with LHR <1 (hazard ratio, 0.30; P = .007), thoracic liver position (hazard ratio, 0.38; P < .001), and more aberrant stomach position (hazard ratios, 0.28 [P = .002]; 0.1 [P < .001]; and 0.07 [P < .001]). CONCLUSION Fetal ultrasound markers of CDH severity are predictive not only of death but also of significant morbidity. LHR <1, thoracic liver, and aberrant stomach position are associated with delayed time to resolution of PH in infants with CDH and may be used to identify fetuses at high risk of persistent PH.
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Affiliation(s)
- Leslie A Lusk
- Division of Neonatology, Department of Pediatrics, Benioff Children's Hospital, University of California, San Francisco, CA.
| | - Katherine C Wai
- School of Medicine, University of California, San Francisco, CA
| | | | - Amaya M Basta
- Department of Radiology and Biomedical Imaging, Medical Center, University of California, San Francisco, CA
| | - Roy Filly
- Department of Radiology and Biomedical Imaging, Medical Center, University of California, San Francisco, CA
| | - Roberta L Keller
- Division of Neonatology, Department of Pediatrics, Benioff Children's Hospital, University of California, San Francisco, CA; Fetal Treatment Center, University of California, San Francisco, CA
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12
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Ruano R, Javadian P, Kailin JA, Maskatia SA, Shamshirsaz AA, Cass DL, Zamora IJ, Sangi-Haghpeykar H, Lee TC, Ayres NA, Mehollin-Ray A, Cassady CI, Fernandes C, Welty S, Belfort MA, Olutoye OO. Congenital heart anomaly in newborns with congenital diaphragmatic hernia: a single-center experience. Ultrasound Obstet Gynecol 2015; 45:683-688. [PMID: 25158239 DOI: 10.1002/uog.14648] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Revised: 05/31/2014] [Accepted: 08/07/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To evaluate the impact of the presence of a congenital heart anomaly (CHA) and its potential contribution to morbidity and mortality in infants with congenital diaphragmatic hernia (CDH). METHODS In this retrospective cohort study, prenatal and postnatal data of all newborns diagnosed with CDH between January 2004 and December 2012 in a single center were reviewed. Cases were classified into two groups: those with 'isolated' CDH and those with both CDH and CHA. Patients with CHA were further subclassified into those with a major or minor CHA based on the Risk Adjustment for Congenital Heart Surgery-1 (RACHS-1), and the Society of Thoracic Surgeons-European Association for Cardiothoracic Surgery (STS-EACTS) scoring systems. Patients with associated non-cardiac anomalies, including 'syndromic cases', were excluded from the analysis. Primary and secondary outcomes were survival up to 1 year of age and a need for extracorporeal membrane oxygenation (ECMO), respectively. RESULTS Of the 180 infants with CDH, 41 were excluded because of the presence of non-cardiac associated anomalies, 118 had isolated CDH and 21 had CDH with CHA (16 with minor and five with major CHA). Receiver-operating characteristics curve analysis demonstrated that the best cut-off for survival was when the score for CHA was ≤ 2 for both RACHS-1 (area under the curve (AUC), 0.74 (P = 0.04); sensitivity, 80.0%; specificity, 87.5%) and STS-EACTS (AUC, 0.83 (P = 0.03); sensitivity, 100%; specificity, 87.5%). Survival rate at 1 year was significantly lower in those with CHD and a major CHA (40.0%; P = 0.04) than in those with isolated CDH (77.1%) and those with CDH and a minor CHA (81.3%). We found no significant differences among the groups with regard to the need for ECMO. CONCLUSIONS In general, a milder form of CHA does not appear to have a negative impact on the survival of infants with CDH. However, mortality appears to be significantly higher in infants with CDH and a major form of CHA. The scoring systems appear to be useful as predictors for classifying the effects of CHA in this population of patients.
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Affiliation(s)
- R Ruano
- Department of Obstetrics and Gynecology, Texas Children's Fetal Center and Baylor College of Medicine, Houston, TX, USA
| | - P Javadian
- Department of Obstetrics and Gynecology, Texas Children's Fetal Center and Baylor College of Medicine, Houston, TX, USA
| | - J A Kailin
- Department of Pediatrics, Division of Cardiology, Texas Children's Fetal Center and Baylor College of Medicine, Houston, TX, USA
| | - S A Maskatia
- Department of Pediatrics, Division of Cardiology, Texas Children's Fetal Center and Baylor College of Medicine, Houston, TX, USA
| | - A A Shamshirsaz
- Department of Obstetrics and Gynecology, Texas Children's Fetal Center and Baylor College of Medicine, Houston, TX, USA
| | - D L Cass
- Michael E. DeBakey Department of Surgery, Texas Children's Fetal Center and Baylor College of Medicine, Houston, TX, USA
| | - I J Zamora
- Michael E. DeBakey Department of Surgery, Texas Children's Fetal Center and Baylor College of Medicine, Houston, TX, USA
| | - H Sangi-Haghpeykar
- Department of Obstetrics and Gynecology, Texas Children's Fetal Center and Baylor College of Medicine, Houston, TX, USA
| | - T C Lee
- Michael E. DeBakey Department of Surgery, Texas Children's Fetal Center and Baylor College of Medicine, Houston, TX, USA
| | - N A Ayres
- Department of Pediatrics, Division of Cardiology, Texas Children's Fetal Center and Baylor College of Medicine, Houston, TX, USA
| | - A Mehollin-Ray
- Department of Radiology, Texas Children's Fetal Center and Baylor College of Medicine, Houston, TX, USA
| | - C I Cassady
- Department of Radiology, Texas Children's Fetal Center and Baylor College of Medicine, Houston, TX, USA
| | - C Fernandes
- Department of Pediatrics, Division of Neonatology, Texas Children's Fetal Center and Baylor College of Medicine, Houston, TX, USA
| | - S Welty
- Department of Pediatrics, Division of Neonatology, Texas Children's Fetal Center and Baylor College of Medicine, Houston, TX, USA
| | - M A Belfort
- Department of Obstetrics and Gynecology, Texas Children's Fetal Center and Baylor College of Medicine, Houston, TX, USA
| | - O O Olutoye
- Michael E. DeBakey Department of Surgery, Texas Children's Fetal Center and Baylor College of Medicine, Houston, TX, USA
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13
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Spaggiari E, Stirnemann JJ, Sonigo P, Khen-Dunlop N, De Saint Blanquat L, Ville Y. Prenatal prediction of pulmonary arterial hypertension in congenital diaphragmatic hernia. Ultrasound Obstet Gynecol 2015; 45:572-577. [PMID: 24976012 DOI: 10.1002/uog.13450] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 06/12/2014] [Accepted: 06/19/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To evaluate the role of prenatal prognostic markers obtained routinely by ultrasound examination and magnetic resonance imaging (MRI) in the prediction of development of postnatal pulmonary arterial hypertension (PAH) in isolated congenital diaphragmatic hernia (CDH). METHODS One hundred and ten cases of isolated CDH were referred to our fetal medicine unit between January 2004 and April 2013. Mortality and morbidity rates were reviewed for those presenting with postnatal PAH. The following prenatal markers were evaluated as potential predictive factors of PAH: liver position, side of the CDH defect, lung area to head circumference ratio (LHR) and observed/expected LHR (o/e-LHR), which were measured by ultrasound, and observed/expected total fetal lung volume (o/e-TFLV), which was measured by MRI. Univariable logistic regression was used to assess associations. RESULTS PAH was significantly associated with perinatal mortality and morbidity (P < 0.001). The occurrence of PAH decreased significantly with an increasing LHR, o/e-LHR and o/e-TFLV and was significantly increased for cases with an intrathoracic liver, but not for those with right-sided defects. Univariable regression revealed that o/e-TFLV (odds ratio (OR), 0.9 (95% CI, 0.86-0.95); P < 0.05 for percentage unit change in o/e), LHR (OR, 0.19 (95% CI, 0.09-0.40); P < 0.05 for unit change), o/e-LHR (OR, 0.95 (95% CI, 0.93-0.98); P < 0.05 for percentage unit change in o/e) and liver position (OR, 2.82 (95% CI, 1.13-7.00); P < 0.05 for intrathoracic liver) were significant predictors of subsequent PAH. No differences were found after adjusting for gestational age at delivery. The areas under the receiver-operating characteristics curve were 0.80 and 0.75 for o/e-TFLV and o/e-LHR, respectively. CONCLUSION In cases of CDH, PAH is associated with high rates of mortality and morbidity. Routinely obtained prenatal markers, usually used for the assessment of pulmonary hypoplasia, are also relevant for the postnatal prediction of PAH.
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MESH Headings
- Female
- Gestational Age
- Head
- Hernias, Diaphragmatic, Congenital/diagnosis
- Hernias, Diaphragmatic, Congenital/embryology
- Hernias, Diaphragmatic, Congenital/pathology
- Humans
- Hypertension, Pulmonary/diagnosis
- Hypertension, Pulmonary/embryology
- Hypertension, Pulmonary/pathology
- Infant, Newborn
- Liver/embryology
- Liver/pathology
- Lung/embryology
- Lung/pathology
- Lung Volume Measurements/methods
- Predictive Value of Tests
- Pregnancy
- Prognosis
- Survival Rate
- Ultrasonography, Prenatal
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Affiliation(s)
- E Spaggiari
- Department of Obstetrics and Maternal-Fetal Medicine, Necker-Enfants Malades Hospital, AP-HP, Paris, France; University Paris Descartes, Sorbonne Paris-Cité, Paris, France
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14
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Ruano R, Britto ISW, Sangi-Haghpeykar H, Bussamra LCS, Da Silva MM, Belfort MA, Deter RL, Lee W, Tannuri U, Zugaib M. Longitudinal assessment of lung area measurements by two-dimensional ultrasound in fetuses with isolated left-sided congenital diaphragmatic hernia. Ultrasound Obstet Gynecol 2015; 45:566-571. [PMID: 24862641 DOI: 10.1002/uog.13420] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Revised: 05/10/2014] [Accepted: 05/16/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To evaluate lung growth in healthy fetuses and those with congenital diaphragmatic hernia (CDH) using two-dimensional (2D) ultrasound. METHODS Fetal right lung measurements obtained by 2D ultrasound between 19 and 37 weeks' gestation were evaluated longitudinally in 66 healthy fetuses and 52 fetuses with isolated left-sided CDH. Right lung areas were determined by the 'tracing' and 'longest-diameters' methods and, subsequently, lung area-to-head circumference ratios (LHRs) were calculated. Functions fitted to these size parameters with respect to gestational age were evaluated for three sets of group-wise comparisons: (1) healthy vs CDH fetuses; (2) different degrees of severity of CDH; and (3) CDH fetuses that survived vs those that died by 6 months postpartum. RESULTS There was a significantly slower increase in right lung areas and LHRs with advancing gestational age in CDH fetuses than in healthy individuals (P < 0.05). Compared to those with milder forms of CDH, lung areas and LHRs of fetuses with more severe forms displayed a smaller increase (P < 0.05) and LHRs of fetuses with severe CDH did not increase during pregnancy (P > 0.05). Individuals who died postpartum did not show any increase in LHR (P > 0.05) throughout gestation. CONCLUSIONS The right lung area and LHR, calculated using either the longest-diameters or tracing method, display reduced growth rates during gestation in cases of isolated left-sided CDH as compared with healthy fetuses. The growth curve characteristics of fetal lung areas and LHRs may be useful for predicting neonatal mortality.
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Affiliation(s)
- R Ruano
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital Fetal Center, Houston, TX, USA; Department of Obstetrics and Gynecology, Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, Brazil
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15
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Britto ISW, Araujo Júnior E, Sangi-Haghpeykar H, Bussamra LCS, Deter RL, Belfort MA, Lee W, Ruano R. Reference ranges for 2-dimensional sonographic lung measurements in healthy fetuses: a longitudinal study. J Ultrasound Med 2014; 33:1917-1923. [PMID: 25336478 DOI: 10.7863/ultra.33.11.1917] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVES The purpose of this study was to establish reference ranges for 2-dimensional sonographic measurements of fetal lungs from longitudinal data. METHODS A total of 214 fetal lung measurements were longitudinally evaluated in 62 healthy fetuses between 20 and 36 weeks' menstrual age. Both right and left lung areas were measured in the heart 4-chamber view using lung area tracing and axis diameter methods. Multilevel modeling was used to evaluate the expected values and variability with respect to menstrual age and to generate reference ranges for the lung area, lung-to-head ratio, quantitative lung index, and observed-to-expected lung-to-head ratio for both lungs. RESULTS The expected values varied with menstrual age for all parameters. Variance was menstrual age dependent for all parameters except the longest diameter area measurements and their lung-to-head ratios. CONCLUSIONS Models are presented for expected 2-dimensional sonographic lung size parameters and their variance as a function of menstrual age. These data have been used to generate age-specific reference ranges for both measurements and indices.
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Affiliation(s)
- Ingrid Schwach Werneck Britto
- Department of Obstetrics and Gynecology, Medical Science College of Santa Casa of São Paulo, São Paulo, Brazil (I.S.W.B., L.C.S.B.); Department of Obstetrics, Federal University of São Paulo, São Paulo, Brazil (E.A.J.); and Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine and Texas Children's Hospital Fetal Center, Houston, Texas USA (H.S.-H., R.L.D., M.A.B., W.L., R.R.)
| | - Edward Araujo Júnior
- Department of Obstetrics and Gynecology, Medical Science College of Santa Casa of São Paulo, São Paulo, Brazil (I.S.W.B., L.C.S.B.); Department of Obstetrics, Federal University of São Paulo, São Paulo, Brazil (E.A.J.); and Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine and Texas Children's Hospital Fetal Center, Houston, Texas USA (H.S.-H., R.L.D., M.A.B., W.L., R.R.)
| | - Haleh Sangi-Haghpeykar
- Department of Obstetrics and Gynecology, Medical Science College of Santa Casa of São Paulo, São Paulo, Brazil (I.S.W.B., L.C.S.B.); Department of Obstetrics, Federal University of São Paulo, São Paulo, Brazil (E.A.J.); and Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine and Texas Children's Hospital Fetal Center, Houston, Texas USA (H.S.-H., R.L.D., M.A.B., W.L., R.R.)
| | - Luiz Cláudio Silva Bussamra
- Department of Obstetrics and Gynecology, Medical Science College of Santa Casa of São Paulo, São Paulo, Brazil (I.S.W.B., L.C.S.B.); Department of Obstetrics, Federal University of São Paulo, São Paulo, Brazil (E.A.J.); and Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine and Texas Children's Hospital Fetal Center, Houston, Texas USA (H.S.-H., R.L.D., M.A.B., W.L., R.R.)
| | - Russell L Deter
- Department of Obstetrics and Gynecology, Medical Science College of Santa Casa of São Paulo, São Paulo, Brazil (I.S.W.B., L.C.S.B.); Department of Obstetrics, Federal University of São Paulo, São Paulo, Brazil (E.A.J.); and Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine and Texas Children's Hospital Fetal Center, Houston, Texas USA (H.S.-H., R.L.D., M.A.B., W.L., R.R.)
| | - Michael A Belfort
- Department of Obstetrics and Gynecology, Medical Science College of Santa Casa of São Paulo, São Paulo, Brazil (I.S.W.B., L.C.S.B.); Department of Obstetrics, Federal University of São Paulo, São Paulo, Brazil (E.A.J.); and Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine and Texas Children's Hospital Fetal Center, Houston, Texas USA (H.S.-H., R.L.D., M.A.B., W.L., R.R.)
| | - Wesley Lee
- Department of Obstetrics and Gynecology, Medical Science College of Santa Casa of São Paulo, São Paulo, Brazil (I.S.W.B., L.C.S.B.); Department of Obstetrics, Federal University of São Paulo, São Paulo, Brazil (E.A.J.); and Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine and Texas Children's Hospital Fetal Center, Houston, Texas USA (H.S.-H., R.L.D., M.A.B., W.L., R.R.)
| | - Rodrigo Ruano
- Department of Obstetrics and Gynecology, Medical Science College of Santa Casa of São Paulo, São Paulo, Brazil (I.S.W.B., L.C.S.B.); Department of Obstetrics, Federal University of São Paulo, São Paulo, Brazil (E.A.J.); and Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine and Texas Children's Hospital Fetal Center, Houston, Texas USA (H.S.-H., R.L.D., M.A.B., W.L., R.R.).
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16
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Ruano R, Lazar DA, Cass DL, Zamora IJ, Lee TC, Cassady CI, Mehollin-Ray A, Welty S, Fernandes CJ, Haeri S, Belfort MA, Olutoye OO. Fetal lung volume and quantification of liver herniation by magnetic resonance imaging in isolated congenital diaphragmatic hernia. Ultrasound Obstet Gynecol 2014; 43:662-669. [PMID: 24127326 DOI: 10.1002/uog.13223] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Revised: 08/20/2013] [Accepted: 10/01/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To determine associations between fetal lung and liver herniation volumes measured by magnetic resonance imaging (MRI) and mortality/need for extracorporeal membrane oxygenation (ECMO) in cases of isolated congenital diaphragmatic hernia (CDH). A secondary objective was to compare prenatal MRI parameters with two-dimensional ultrasound lung measurements. METHODS A retrospective review of medical records of all fetuses with isolated CDH evaluated between January 2004 and July 2012 was performed. The following MRI parameters were measured at 20-32 weeks: observed/expected total fetal lung volume (o/e-TLV), predicted pulmonary volume (PPV), percentage of liver herniated into the fetal thorax (%LH) and the liver/thoracic volume ratio (LiTR). These were compared with the ultrasound-determined lung-to-head ratio (LHR) and the observed/expected LHR (o/e-LHR) in the same cohort. The predictive value of MRI and ultrasound parameters for mortality and the need for ECMO was evaluated by univariate, multivariate and factor analysis and by receiver-operating characteristics curves. RESULTS Eighty fetuses with isolated CDH were evaluated. Overall mortality was 18/80 (22.5%). Two newborns died a few hours after birth. ECMO was performed in 29/78 (37.2%) newborns, with a survival rate of 48.3% (14/29). The side of the diaphragmatic defect was not associated with mortality (P = 0.99) or the need for ECMO (P = 0.48). Good correlation was observed among o/e-TLV, PPV, LHR and o/e-LHR as well as between %LH and LiTR (r = 0.89; P < 0.01); however, fetal lung measurements and measures of liver herniation were not correlated (all P > 0.05). All parameters were statistically associated with mortality or the need for ECMO. The best combination of measurements to predict mortality was o/e-TLV and %LH, with 83% accuracy. CONCLUSION Mortality and the need for ECMO in neonates with isolated CDH can be best predicted using a combination of MRI o/e-TLV and %LH.
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Affiliation(s)
- R Ruano
- Texas Children's Fetal Center, Texas Children's Hospital, Houston, TX, USA; Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA
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17
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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. J Ultrasound Med 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] [What about the content of this article? (0)] [Affiliation(s)] [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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18
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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. J Ultrasound Med 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] [What about the content of this article? (0)] [Affiliation(s)] [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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