Antenatal predictors of outcome in prenatally diagnosed congenital diaphragmatic hernia (CDH)

Oluyomi-Obi, Titilayo; Kuret, Verena; Puligandla, Pramod S.; Lodha, Abhay; Robertson, Helen Lee; Lee, Kovid; Somerset, David; Johnson, Jo-Ann; Ryan, Greg

doi:10.1016/j.jpedsurg.2016.12.008

Cited by 110 publications

(99 citation statements)

References 30 publications

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“…Ultrasound Obstet Gynecol. 2005;26:718‐24. ¶Other: Combination of references or references not specified.…”

Section: Resultsmentioning

confidence: 99%

“…Subsequently, Jani et al introduced the observed‐to‐expected LHR (o/e LHR) to correct for the exponential growth in normal fetal lung volumes with advancing gestational age (GA), calculated by expressing the observed LHR as a percentage of the expected mean LHR for GA . Neonatal mortality and morbidity have been shown to correlate with both LHR and o/e LHR …”

Section: Introductionmentioning

confidence: 99%

“…Subsequently, Jani et al introduced the observed-to-expected LHR (o/e LHR) to correct for the exponential growth in normal fetal lung volumes with advancing gestational age (GA), calculated by expressing the observed LHR as a percentage of the expected mean LHR for GA. 3 Neonatal mortality and morbidity have been shown to correlate with both LHR 2,4,5 and o/e LHR. 3,6,7 Although sonographic lung area measurement is the basis of antenatal prognostication and selection for fetal endoscopic tracheal occlusion (FETO), the predictive value of LHR for neonatal outcomes has been variable. 3,5,[8][9][10][11] Undoubtedly, part of the variation in the prognostic value of antenatal lung area measurements may be related to a smaller sample size in some series.…”

Section: Introductionmentioning

confidence: 99%

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Variability in antenatal prognostication of fetal diaphragmatic hernia across the North American Fetal Therapy Network (NAFTNet)

et al. 2019

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Objective To evaluate variability in antenatal sonographic prognostication of congenital diaphragmatic hernia (CDH) within the North American Fetal Therapy Network (NAFTNet). Methods NAFTNet centre were invited to complete a questionnaire and participate in videoconference calls, during which participants were observed while measuring lung area by ultrasound using the anteroposterior (AP) method, longest method, and trace method. Each center identified 1–2 experienced fetal medicine specialist(s) or medical imaging specialists locally to participate in the study. Practices were compared among NAFTNet centre within and without the fetal endoscopic tracheal occlusion (FETO) consortium. Results Nineteen participants from 9 FETO center and 30 participants from 17 non‐FETO center completed the survey and 31 participants were interviewed and observed while measuring sonographic lung area. All Centres measured observed‐to‐expected lung‐to‐head ratio (o/e LHR) or LHR for CDH prognostication. Image selection criteria for lung area measurement were consistent, including an axial section of the chest with clear lung borders and a 4‐chamber cardiac view. Lung area measurement methods varied across NAFTNet, with most centre using longest (4/9 FETO vs. 13/29 non‐FETO) or trace (3/9 FETO vs. 11/29 non‐FETO) method. Centres differed in expected reference ranges for o/e LHR determination and whether the lowest, highest or average o/e LHR was utilized. Conclusion Variability in antenatal sonographic prognostication of CDH was identified across NAFTNet, indicating a need for consensus‐based standardization.

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“…Ultrasound Obstet Gynecol. 2005;26:718‐24. ¶Other: Combination of references or references not specified.…”

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Variability in antenatal prognostication of fetal diaphragmatic hernia across the North American Fetal Therapy Network (NAFTNet)

et al. 2019

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“…The incidence of CDH is estimated at 1 in 2500 to 5000 newborns with approximately 60% of cases being diagnosed on prenatal ultrasound . As pulmonary hypoplasia is a major contributor to neonatal morbidity and mortality in CDH, antenatal prognostication relies heavily on sonographic fetal lung volume estimation by obtaining the observed to expected lung‐to‐head ratio (o/e LHR), which has been shown to correlate well with neonatal survival . Poor sonographic antenatal prognosticators include a low o/e LHR, usually defined as less than 25% and intrathoracic liver herniation, which are both independently suggestive of a large diaphragmatic defect and thus considerable mass effect …”

Section: Introductionmentioning

confidence: 99%

Reproducibility of fetal lung‐to‐head ratio in left diaphragmatic hernia across the North American Fetal Therapy Network (NAFTNet)

et al. 2019

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Objective To determine the antenatal sonographic lung area measurement method in left congenital diaphragmatic hernia (CDH) with the highest interrater agreement among North American Fetal Therapy Network (NAFTNet) centers within and outside the fetoscopic tracheal occlusion (FETO) consortium and in comparison with a European “expert” reviewer (ER). Methods Nineteen members from nine FETO consortium centers and 29 reviewers from 17 non‐FETO centers reviewed ultrasound clips of the chest from 13 fetuses with isolated left CDH and were asked to select a static plane for lung area measurement using anteroposterior (AP), longest, and trace methods. Interrater agreement in lung area measurements was determined using intraclass correlation coefficient (ICC). Bland‐Altman analysis was used to evaluate mean difference (bias) between NAFTNet reviewers and ER. Results Among FETO centers, agreement was highest using trace (ICC 0.94; 95% CI, 0.83‐0.98), followed by longest (ICC 0.89; 95% CI, 0.75‐0.97) and lowest for A‐P (ICC 0.83; 95% CI, 0.67‐0.94). Similar trends were noted in non‐FETO centers. When compared with ER, bias was lowest for trace: 14 ± 38 mm2 and 19 ± 36 mm2 for FETO and non‐FETO centers, respectively. Conclusion The trace method demonstrated the highest interrater agreement and lowest bias for lung area estimation in left CDH across NAFTNet.

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“…Meanwhile research is ongoing on comprehensive assessment of fetuses with isolated CDH, both in terms of predicting lung hypoplasia, pulmonary hypertension, and cardiac function . An increasing number of studies on fetal MR demonstrate how widespread this methodology is, whereas its superiority continues to be uncertain …”

Section: Fetal Surgerymentioning

confidence: 99%

In case you missed it: The Prenatal Diagnosis editors bring you the most significant advances of 2017

et al. 2018

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Antenatal predictors of outcome in prenatally diagnosed congenital diaphragmatic hernia (CDH)

Cited by 110 publications

References 30 publications

Variability in antenatal prognostication of fetal diaphragmatic hernia across the North American Fetal Therapy Network (NAFTNet)

Variability in antenatal prognostication of fetal diaphragmatic hernia across the North American Fetal Therapy Network (NAFTNet)

Reproducibility of fetal lung‐to‐head ratio in left diaphragmatic hernia across the North American Fetal Therapy Network (NAFTNet)

In case you missed it: The Prenatal Diagnosis editors bring you the most significant advances of 2017

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