Utility of Fetal Cardiac Axis and Cardiac Position Assessment in Predicting Neonatal Respiratory Morbidity in Fetal Congenital Lung Lesions

Abstract

Objectives-To assess the diagnostic performance of the fetal cardiac axis (CA) and/or cardiac position (CP) versus the congenital pulmonary malformation volume ratio (CVR) in predicting any and severe neonatal respiratory morbidity in fetal congenital lung lesions.Methods-This work was an 11-year retrospective cohort study. The sensitivity, specificity, positive predictive value, and negative predictive value of CA and/or CP assessment in prediction of respiratory morbidity were calculated before 24 weeks' gestation and between 24 and 32 weeks and compared to CVR cutoffs obtained from the literature.Results-Fifty-three patients were included. CA and/or CP abnormalities were present in 45% and 38% of patients before 24 weeks and between 24 and 32 weeks and were significantly more common in left-versus rightsided lesions (60% versus 17%; P = .003). The sensitivity, specificity, positive predictive value, and negative predictive value of an abnormal CA and/or CP for any and severe respiratory morbidity were 0.67, 0.61, 0.33, and 0.86 and 0.8, 0.58, 0.17, and 0.97 before 24 weeks and 0.75, 0.73, 0.45, and 0.91 and 0.8, 0.67, 0.20, and 0.97 between 24 and 32 weeks, respectively. An abnormal CA and/or CP had higher sensitivity for any respiratory morbidity compared to the CVR at 0.5 and 0.8 cutoffs both before 24 weeks and between 24 and 32 weeks (P < .05).Conclusions-An abnormal CA and/or CP before 24 weeks and between 24 and 32 weeks has higher sensitivity for the detection of any respiratory morbidity at birth compared to the CVR at both 0.5 and 0.8 cutoffs. A normal CA and CP have a high negative predictive value for excluding any respiratory morbidity at birth both before 24 weeks and between 24 and 32 weeks.

Fetal Risk Stratification and Outcomes in Children with Prenatally Diagnosed Lung Malformations

“…[15][16][17][45][46][47][48] Unfortunately, nearly all of these previous studies were hampered by low patient numbers and a single center study design, while others did not fully endorsed the utility of CVR as a reliable predictor of outcome. 18,35,49 Four symptomatic fetuses with a maximum CVR > 0.9 were not delivered at affiliated birth centers, and CVR measurements were missing from reports in half of all cases. Given our prenatal risk stratification data and the maternal-fetal medicine practice variation that currently exists in routinely measuring the CVR, there is an opportunity for standardization and quality improvement in ultrasound evaluations performed for this condition.…”

“…15–17,45–48 Unfortunately, nearly all of these previous studies were hampered by low patient numbers and a single center study design, while others did not fully endorsed the utility of CVR as a reliable predictor of outcome. 18,35,49…”

“…[10][11][12] As a result, there has been a shift in focus toward developing risk stratification tools to better counsel families on timing of surgery and the potential for adverse postnatal outcomes in affected infants. [13][14][15][16][17][18][19][20] Despite these efforts, recent studies have been limited by low patient numbers, and the majority of prenatal predictors of outcome have not been well validated in a multicenter fashion. 21 Using a multi-institutional database, our primary objective was to correlate prenatal imaging characteristics with clinical outcomes in CLM patients.…”

Predicting the risk of respiratory distress in newborns with congenital pulmonary malformations

“…Most CPMs are asymptomatic at birth. Retrospective evaluations have revealed a prevalence of neonatal symptoms of 22-25% [2][3][4]. The reported prevalence is lower, at about 9-17%, if the outcome is defined by the need for ventilatory support [3][4][5][6][7][8].…”

“…Retrospective evaluations have revealed a prevalence of neonatal symptoms of 22-25% [2][3][4]. The reported prevalence is lower, at about 9-17%, if the outcome is defined by the need for ventilatory support [3][4][5][6][7][8]. The true prevalence of symptomatic CPM may be even lower, as these retrospective and, often, single-centre studies may not have taken all prenatally diagnosed CPMs into account, particularly the smaller ones.…”