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Methods: Prospective follow-up of women referred for evaluation of CDH in a tertiary referral center with availability of extracorporeal membrane oxygenation (ECMO), NICU, fetal medicine specialists, and pediatric surgeons. Only those with available LHR measurements were included. Results: During the period of time from August 1999 to April 2003 there were 13 women with prenatal diagnosis of CDH with available LHR measurements. The mean gestational age at diagnosis was 23 weeks (range 20-31 weeks), 11 (85%) were left sided CDH. There were no major associated anomalies. The mean LHR measurement was 1.32 (range 0.57-2.19). Two women terminated the pregnancy (LHR 0.57 and 1.02), and one suffered intrauterine fetal demise (LHR 1.35). The remaining ten neonates reached term, were delivered vaginally, and were operated within an average of 52 hours from delivery (range 26-72 hours). Only one neonate died, for a mortality rate of 10%. There are no additional deaths in this group for a mean follow-up of 18 months (range 7-36 months). The background mortality rate for all CDH neonates in our institution is 35%.Conclusions: It appears that measurement of the LHR has created a highly selective group with an improved outcome within the total group of neonates with prenatal diagnosis of CDH. P259The validity of using the lung-to-head-ratio in fetuses with congenital diaphragmatic hernia to predict the neonatal outcome

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