APSA PaperFetal lung-head ratio is not related to outcome for antenatal diagnosed congenital diaphragmatic hernia
Section snippets
Methods
All antenatal patient records with a diagnosis of CDH from January of 2002 to June of 2005 were examined. Inclusion criteria were as follows: all patients who had at least 1 comprehensive antenatal evaluation and LHR measurement at the Center for Prenatal Pediatrics and all patients who were delivered at this institution and managed solely in our neonatal intensive care unit, based on a previously published respiratory care strategy [9]. Only fetuses with an isolated left sided CDH and no
Results
A total of 42 patients were seen in The Center for Prenatal Pediatrics with an antenatal diagnosis of CDH. Twenty-eight met inclusion criteria for this study and constitute the study population. The mean gestational age of our fetuses at the time of LHR measurement in this study was 27 weeks (range, 17-36 weeks). The median gestational age was 26 weeks.
Overall survival in this population was 86% (24/28). Postnatal survival in fetuses with LHR of 1.0 or lower (8/11) was not statistically
Discussion
Lung-to-head ratio, first described in 1996, has been suggested by some centers to be predictive of postnatal survival [3], [6], [11]. This radiologic calculation has been further used to justify fetal or antenatal intervention in hopes of improving survival in high-risk fetuses [4]. Based on previously published data, some centers have assigned an LHR value of 1.0 as an index for very poor prognosis and subsequent fetal intervention, especially in combination with herniation of the fetal liver
References (17)
- et al.
Current consequences of prenatal diagnosis of congenital diaphragmatic hernia
J Pediatr Surg
(2006) - et al.
Congenital diaphragmatic hernia in 120 infants treated consecutively with permissive hypercapnea/spontaneous respiration/elective repair
J Pediatr Surg
(2002) - et al.
Congenital diaphragmatic hernia: survival treated with very delayed surgery, spontaneous respiration, and no chest tube
J Pediatr Surg
(1995) - et al.
Fetal intervention for congenital diaphragmatic hernia: the European experience
Semin Perinatol
(2005) - et al.
The relationship of pulmonary artery pressure and survival in congenital diaphragmatic hernia
J Pediatr Surg
(2004) - et al.
Analysis of an improved survival rate for congenital diaphragmatic hernia
J Pediatr Surg
(2003) Congenital diaphragmatic hernia
Curr Probl Surg
(1994)What do survivors of congenital diaphragmatic hernia look like when they grow up?
Semin Pediatr Surg
(1996)
Cited by (81)
Prediction tools in congenital diaphragmatic hernia
2020, Seminars in PerinatologyCitation Excerpt :Additionally, LHR was initially designed only for left CDH using the right lung area, and published ranges for outcomes prediction are largely based on LHR data calculated at 24–26 weeks’ GA, which renders LHR measurements outside this range less accurate for prediction.14 For these reasons, simple LHR has fallen out of favor, particularly after publication of data showing poor prognostic accuracy.8,15 In 2005, publication of a valuable report established reference LHR values in 650 normal fetuses throughout gestation.16
Lipocalin 2 as a new biomarker for fetal lung hypoplasia in congenital diaphragmatic hernia
2016, Clinica Chimica ActaAdvances in prenatal diagnosis of congenital diaphragmatic hernia
2014, Seminars in Fetal and Neonatal MedicinePrenatal MRI fetal lung volumes and percent liver herniation predict pulmonary morbidity in congenital diaphragmatic hernia (CDH)
2014, Journal of Pediatric SurgeryStandardized reporting for congenital diaphragmatic hernia - An international consensus
2013, Journal of Pediatric SurgeryCitation Excerpt :Chest radiographs are of no value in predicting severity of illness in infants with CDH [27]. Ultrasound and MRI have been used to develop prenatal estimates of pulmonary hypoplasia but these measurements have not been studied in a rigorous, multi-institutional fashion or validated against postnatal anatomic information [28,29]. While many of our centers use potentially useful perinatal markers such as MRI calculated lung volumes, standardized methods to determine volumes have not yet been validated across multiple centers and may not be generalizable [30].
Presented at the 37th Annual Meeting of the American Pediatric Surgical Association, May 20–24, 2006, Hilton Head, SC.