Congenital diaphragmatic hernia: an evaluation of the prognostic value of the lung‐to‐head ratio and other prenatal parameters

Laudy, J. A. M.; Gucht, M. Van; Dooren, Marieke F. van; Wladimiroff, J. W.; Tibboel, Dick

doi:10.1002/pd.654

Cited by 175 publications

(121 citation statements)

References 27 publications

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“…13 Furthermore, although lung-to-head ratio (LHR) is a prominent parameter to predict the prognoses of CDH, a significant number of cases exist in the narrow range between 1.0 and 1.4 exactly. 10,14 Therefore, LHR is used as a prognostic marker combined with the location of the liver. 15 In Japan, systematic fetal screening has not been established; therefore, gestation at diagnosis of CDH tends to be late, resulting in delay in assessing LHR.…”

Section: Discussionmentioning

confidence: 99%

Prediction of postnatal outcomes in congenital diaphragmatic hernia using MRI signal intensity of the fetal lung

et al. 2010

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Objective: Prognostic prediction in prenatally diagnosed congenital diaphragmatic hernia (CDH) is needed. The aim of the study was to evaluate magnetic resonance imaging (MRI) signal intensity of the fetal lung as a predictor of prognosis in CDH.Study Design: The subjects consisted of 12 fetuses with prenatally diagnosed CDH, who were treated soon after the birth in our institution. They all underwent MRI at 29 to 37 weeks of gestation. The ratio of the lung signal intensity to the spinal fluid signal intensity (L/SF) was calculated using region-of-interest analysis of T2-weighted images. The relationship between L/SF and clinical data was then examined.Result: L/SF were significantly larger in survivors compared with deaths (0.815 vs 0.614, P<0.05). In survivors, L/SF significantly correlated with duration of tracheal intubation (rs ¼ À0.938, P<0.01).Conclusion: L/SF is a unique factor to predict the survival prognosis and likely to quantify the degree of pulmonary hypoplasia in CDH.

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Section: Discussionmentioning

confidence: 99%

Prediction of postnatal outcomes in congenital diaphragmatic hernia using MRI signal intensity of the fetal lung

et al. 2010

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“…In fact, studies demonstrated a two to four fold increase in mortality among prenatally diagnosed CDH patients when compared with postnatally diagnosed patients (Skari et al, 2000). Although the reason behind this association is not clear, prenatal diagnosis of CDH may infer that the defect is larger with more displaced bowel and worse pulmonary hypoplasia (Laudy et al, 2003;Heling et al, 2005). Also, prenatal diagnosis has been associated with higher frequency of associated abnormalities, which may contribute to decreased survival of CDH children (Skari et al, 2002).…”

Section: Prenatal Identificationmentioning

confidence: 99%

“…The most commonly used method to assess fetal lung volume, and subsequent outcomes, is the measurement of lung area to head circumference ratio (LHR) with the use of 2-dimensional ultrasound (US) (Metkus et al, 1996;Sbragia et al, 2000;Laudy et al, 2003;Heling et al, 2005;Jani et al, 2006a;Hedrick et al, 2007;S.H. Yang et al, 2007;Sinha et al, 2009).…”

Section: Lung To Head Ratiomentioning

confidence: 99%

Predictors of Mortality and Morbidity in Infants with CDH

Aly¹,

Abdel‐Hady²

2012

Congenital Diaphragmatic Hernia - Prenatal to Childhood Management and Outcomes

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“…A defect of the diaphragm leads to herniation of abdominal organs into the thoracic cavity. Lung hypoplasia and secondary pulmonary hypertension are the major causes of death (2). The implementation of new therapeutic strategies has improved the survival rate even in those patients with severe CDH (3).…”

Section: Abstract Aim: To Prospectively Evaluate Cerebral Perfusion mentioning

confidence: 99%

Cerebral Perfusion After Repair of Congenital Diaphragmatic Hernia with Common Carotid Artery Occlusion After ECMO Therapy

Henzler

Zöllner

Weis

et al. 2017

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Abstract. Aim: To prospectively evaluate cerebral perfusion after repair of congenital diaphragmatic hernia (CDH) and right-common-carotid-artery (rCCA) Congenital diaphragmatic hernia (CDH) occurs in approximately one in 3,000-4,000 live births (1). A defect of the diaphragm leads to herniation of abdominal organs into the thoracic cavity. Lung hypoplasia and secondary pulmonary hypertension are the major causes of death (2). The implementation of new therapeutic strategies has improved the survival rate even in those patients with severe CDH (3). If conservative treatment in newborns with CDH fails, extracorporeal membrane oxygenation (ECMO) therapy is an important alternative for accomplishing sufficient oxygenation of the newborns. The Congenital Diaphragmatic Hernia Study Group showed an improved survival rate in patients with CDH after ECMO therapy, in whom, without ECMO, mortality was predicted to be higher than 80% (4). As a consequence, morbidity plays an increasing role in patients with CDH. Not only pulmonary problems but also neurological disorders have been identified as significant morbidities among CDH survivors (5, 6). In a study by McGahren et al., 8/12 (67%) ECMO survivors showed delayed neurological development compared to only 5/21(24%) of the non-ECMO-treated survivors.In CDH, veno-arterial ECMO is usually performed. Vascular access is usually achieved by insertion of the ECMO cannulas through the right common carotid artery (rCCA) and the right internal jugular vein. At the time of decannulation, ligation or surgical reconstruction of the rCCA can be performed but secondary occlusion of the surgical reconstructed rCCA can occur (7). Büsing et al. investigated 2-year-old children with history of CDH and reconstruction of the rCCA after ECMO therapy. Their study showed that in 72% of the patients, the rCCA was found to be occluded or highly stenotic using contrast-enhanced magnetic resonance angiography (7). Using Doppler ultrasound in 5-year-old patients, Desai et al. reported that most of the reconstructed rCCAs after ECMO therapy were patent and in only 24% of the patients there was significant 557

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Congenital diaphragmatic hernia: an evaluation of the prognostic value of the lung‐to‐head ratio and other prenatal parameters

Abstract: LHR proved to be a good predictor for fetal outcome, independent of gestational age at the time of the measurement. To substantiate our observation, a prospective multicenter study is warranted.

Cited by 175 publications

References 27 publications

Prediction of postnatal outcomes in congenital diaphragmatic hernia using MRI signal intensity of the fetal lung

Prediction of postnatal outcomes in congenital diaphragmatic hernia using MRI signal intensity of the fetal lung

Predictors of Mortality and Morbidity in Infants with CDH

Cerebral Perfusion After Repair of Congenital Diaphragmatic Hernia with Common Carotid Artery Occlusion After ECMO Therapy

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