Prospective analysis of lung-to-head ratio predicts survival for patients with prenatally diagnosed congenital diaphragmatic hernia

Lipshutz, Gerald S.; Albanese, Craig T.; Feldstein, Vickie A.; Jennings, Russell W.; Housley, H. Tamiko; Beech, Richard; Farrell, Jody A.; Harrison, Michael R.

doi:10.1016/s0022-3468(97)90471-1

Cited by 327 publications

(244 citation statements)

References 8 publications

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“…1 Second, the main prognostic factor considered was the pulmonary size and/or volume, which is evaluated by the lung-over-head ratio (LOHR) 9,10 and the observed/expected fetal lung volume ratio (o/e-FLV). 12,13,16 Cases with LOHR < 1.0 and o/e-FLV < 0.35 are associated with poorer outcome (approximately 90%).…”

Section: Discussionmentioning

confidence: 99%

“…1,7 Nevertheless, in spite of the great advances in prenatal and postnatal diagnosis and management, the mortality rate in neonates with isolated CDH is still high. 8 Recent research has focused on prenatal predictors of neonatal outcome in isolated CDH cases, such as lung/head ratio 9,10 and fetal lung volume, [11][12][13][14][15][16] to differentiate cases with a worse prognosis, in which fetal therapy or termination of pregnancy may be indicated, from those with better prognosis, requiring only specialized postnatal care. [17][18][19] In spite of the worldwide, published experience, there are no data about perinatal results in cases of prenatally diagnosed CDH in Brazil.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Prenatal Diagnosis and Perinatal Outcome of 38 Cases With Congenital Diaphragmatic Hernia: 8-Year Experience of a Tertiary Brazilian Center

Ruano

Bunduki

Silva

et al. 2006

Clinics

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diagnosis and perinatal outcome of 38 cases with congenital diaphragmatic hernia: 8-year experience of a tertiary Brazilian center. Clinics. 2006;61(3):197-202. PURPOSE:To evaluate the perinatal results for neonates with congenital diaphragmatic hernia diagnosed prenatally. METHOD: We reviewed data from 38 cases of congenital diaphragmatic hernia diagnosed prenatally from January 1995 to December 2003 in the Fetal Medicine Unit of the Department of Obstetrics and Gynecology, São Paulo University Medical School. The main data analyzed were gestational age at diagnosis, fetal karyotyping, side of diaphragmatic defect, presence of associated structural malformations, hepatic herniation, and severe mediastinal shift. Perinatal outcomes were obtained by reviewing hospital documents or by directly calling the patients' immediate relatives. RESULTS: Mean gestational age at diagnosis was 29 weeks (range, 16-37 weeks).Thirty (79%) cases had a left diaphragmatic defect and 8 (21%) had a right lesion. Associated structural malformations were observed in 21 (55%) cases, in which 12 fetuses had a normal karyotype and 9 had chromosomal abnormalities. Isolated congenital diaphragmatic hernia was confirmed in 17 (45%) cases. The overall perinatal mortality rate was 92%. Rates of fetal deaths, early neonatal deaths, late neonatal deaths, and survival were 42%, 50%, 0%, and 8%, respectively, in cases with associated structural malformations but normal karyotyping; 56%, 44%, 0%, and 0% for cases with chromosomal abnormalities; and, 0%, 76%, 12%, and 12% in cases with isolated congenital diaphragmatic hernia. The neonatal mortality rate was 89% in cases with isolated congenital diaphragmatic hernia. CONCLUSION: Perinatal mortality was very high in prenatally diagnosed cases of congenital diaphragmatic hernia. Earlier perinatal deaths are associated with the presence of other structural defects or chromosomal abnormalities. In cases of isolated congenital diaphragmatic hernia, mortality is related to the presence of herniated liver, right-sided lesion, and major mediastinal shift.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Prenatal Diagnosis and Perinatal Outcome of 38 Cases With Congenital Diaphragmatic Hernia: 8-Year Experience of a Tertiary Brazilian Center

Ruano

Bunduki

Silva

et al. 2006

Clinics

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“…Second, lung volumes change with too much variance after the gestational week 31. 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.…”

Section: Discussionmentioning

confidence: 99%

“…19 However, the meaning of MRI signal intensity of the CDH lung remains controversial. 13 Factors that influence MRI intensity of fetal lung have been explained as follows. Secretion of lung fluid in future airspace results in an accumulation of free protons and the decrease of the water binding hyaluronic acid fraction, which could be responsible for the changing appearance on T2-weighted sequences.…”

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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“…An LHR ratio > 1.35 is associated with a good outcome whereas an LHR < 0.6 is associated with 0% survival. The LHR has been shown to be predictive of survival in left-sided CDH but it is less useful in rightsided lesions 8,9 . MRI has also been used to assess lung volumes in CDH, correlating well with outcome, but it is not clear whether MRI offers any advantage over sonographic measurements 5,6,10 .…”

Section: Thoracic Abnormalitiesmentioning

confidence: 99%

The selective use of magnetic resonance imaging in prenatal diagnosis

Casele

Meyer

2004

Ultrasound in Obstet & Gyne

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Prospective analysis of lung-to-head ratio predicts survival for patients with prenatally diagnosed congenital diaphragmatic hernia

Cited by 327 publications

References 8 publications

Prenatal Diagnosis and Perinatal Outcome of 38 Cases With Congenital Diaphragmatic Hernia: 8-Year Experience of a Tertiary Brazilian Center

Prenatal Diagnosis and Perinatal Outcome of 38 Cases With Congenital Diaphragmatic Hernia: 8-Year Experience of a Tertiary Brazilian Center

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

The selective use of magnetic resonance imaging in prenatal diagnosis

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