Fetal Lung Volume Appears to Predict Respiratory Morbidity in Congenital Diaphragmatic Hernia

Abstract

Congenital diaphragmatic hernia (CDH) is associated with pulmonary hypoplasia and respiratory morbidity. To assess whether respiratory morbidity during the first 2 years of life in infants with left-sided CDH is associated with fetal lung volume (FLV) evaluated by the observed-to-expected FLV ratio (o/e FLV) on antenatal magnetic resonance imaging (MRI). In this retrospective study, o/e FLV measures were collected. Respiratory morbidity in the first 2 years of life was studied according to two endpoints: treatment with inhaled corticosteroids for >3 consecutive months and hospitalization for any acute respiratory disease. The primary outcome was a favorable progression defined by the absence of either endpoint. Forty-seven patients were included. The median o/e FLV was 39% (interquartile range, 33–49). Sixteen (34%) infants were treated with inhaled corticosteroids and 13 (28%) were hospitalized. The most efficient threshold for a favorable outcome was an o/e FLV ≥ 44% with a sensitivity of 57%, specificity of 79%, negative predictive value of 56%, and positive predictive value of 80%. An o/e FLV ≥ 44% was associated with a favorable outcome in 80% of cases. These data suggest that lung volume measurement on fetal MRI may help to identify children at lower respiratory risk and improve information during pregnancy, patient characterization, decisions about treatment strategy and research, and personalized follow-up.

Thoracic Biometry in Patients with Congenital Diaphragmatic Hernia, a Magnetic Resonance Imaging Study

“…This is of great interest, seeing as in some places MRI is not readily available, and perhaps VOCAL exploration might be a good alternative if it is easier to access. As we already know, lung volume is the best way of assessing severity and also future respiratory morbidity [ 21 ].…”

Long-Term Evaluation of the Shape of the Reconstructed Diaphragm in Patients with Left-Sided Congenital Diaphragmatic Hernia Using Serial Chest Radiographs and Correlation to Further Complications

“…Numerous studies have defined prenatal risk factors, such as total fetal lung volume (TFLV), observed-to-expected lung-to-head ratio (o/e LHR) or intrathoracically herniated liver, as predictive factors for the need of extracorporeal membrane oxygenation (ECMO), as well as for survival and (short-term) morbidity [12][13][14][15][16][17][18][19]. Perinatal parameters such as the CDH study group predictive survival score, initial blood gas variables, the Brindle score, the McGoon index, the 12-24 h Score for Neonatal Acute Physiology, Version II (SNAP-II), the need for ECMO, the use of inhaled nitric oxide (iNO) or defect size, which often correlate with each other, have been found to be associated with survival and shortterm morbidity (e.g., duration of ventilation, chylothorax, hemorrhage, length of hospital stay) [19][20][21][22].…”