AAP paperDefining “liver-up”: does the volume of liver herniation predict outcome for fetuses with isolated left-sided congenital diaphragmatic hernia?
Section snippets
Study cohort
Permission to conduct this study was obtained from the institutional review board (H-26176) of Baylor College of Medicine, Houston, TX. A retrospective medical record review was performed for all fetuses with isolated left-sided Bochdalek-type CDH evaluated with an ultrafast fetal magnetic resonance imaging (MRI) at our fetal center and delivered at our hospital between January 2004 and December 2010. Data were collected and included basic demographics, MRI-based measurements of liver
Results
A total of 53 fetuses with isolated left-sided CDH were evaluated with ultrafast MRI during the study period. Mean maternal age was 27.7 ± 6.1 years, with a mean gestational age at diagnosis of 23.0 ± 5.6 weeks and mean gestational age at birth of 37.9 ± 1.6 weeks (Table 1). The 6-month mortality rate was 21% (n = 11). Extracorporeal membrane oxygenation was in used 36% (n = 19) of cases with a survival rate of 47%. Diaphragmatic repair was performed in 93% (n = 49) of newborns at an average of
Discussion
Liver herniation has been consistently reported as an indicator of poor prognosis in fetuses with CDH [9], [10], [11], [12]. These studies, however, evaluate liver herniation as a dichotomous variable (absent or present) rather than on a continuous spectrum. In utero, a wide variation in the amount of herniated liver can be observed by ultrafast fetal MRI. This imaging modality offers the opportunity to assess liver position and calculate liver volume and percentage of herniation. An earlier
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Both authors contributed equally to this manuscript as co-first authors. Winner of the Jens Rosenkrantz Award for the best oral presentation by a trainee at the American Academy of Pediatrics, Section on Surgery Meeting, October 2011.