Abstract
Purpose
A major determinant of survival in patients with congenital diaphragmatic hernia (CDH)
is severity of pulmonary hypoplasia. This study addresses the comparative effectiveness
of prenatal methods of lung assessment in predicting mortality, extracorporeal membrane
oxygenation (ECMO), and ventilator dependency.
Methods
We retrospectively reviewed all patients born with isolated CDH between 2004 and 2008.
Lung-to-head ratio (LHR) and observed-to-expected LHR (OELHR) were obtained from prenatal
ultrasounds. Percent-predicted lung volume (PPLV) was obtained from fetal MRI (fMRI).
Postnatal data included in-hospital mortality, need for ECMO, and ventilator dependency
at day-of-life 30.
Results
Thirty-seven patients underwent 81 prenatal ultrasounds, while 26 of this sub-cohort
underwent fMRI. Gestational age during imaging study was associated with LHR (p = 0.02), but not OELHR (p = 0.12) or PPLV (p = 0.72). PPLV, min-LHR, and min-OELHR were each associated with mortality (p = 0.03, p = 0.02, p = 0.01), ECMO (p < 0.01, p < 0.01, p = 0.03), and ventilator dependency (p < 0.01, p < 0.01, p = 0.02). For each outcome, PPLV was a more discriminative measure, based on Akaike's
information criterion. Using longitudinal analysis techniques for patients with multiple
ultrasounds, OELHR remained associated with mortality (p = 0.04), ECMO (p = 0.03), and ventilator dependency (p = 0.02), while LHR was associated with ECMO (p = 0.01) and ventilator dependency (p = 0.02) but not mortality (p = 0.06).
Conclusion
When assessing fetuses with CDH, OELHR and PPLV may be most helpful for counseling
regarding postnatal outcomes.
Key words
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Article info
Publication history
Accepted:
March 9,
2013
Received:
February 16,
2013
Footnotes
☆Sources of funding: A.L.M. is the recipient of an NIH (National Heart, Lung, and Blood Institutes) T35 grant.
☆☆Disclosures: None of the authors disclosed any relevant financial relationships.
★Institutional review board: approved, No. HUM00028066.
Identification
Copyright
© 2013 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
