Research article summary (published 30 Dec 2007):

Timing of lung size assessment in the prediction of survival in fetuses with diaphragmatic hernia.

Full Abstract

OBJECTIVES: To investigate whether the prediction of postnatal outcome of fetuses with isolated congenital diaphragmatic hernia depends on the gestational age at assessment using the fetal observed to expected (O/E) lung area to head circumference ratio (LHR), by comparing the performance of the test at 22-23 weeks with that at 32-33 weeks of gestation. METHODS: Following prenatal diagnosis of isolated diaphragmatic hernia before 22 weeks, we evaluated the O/E LHR at 22-32 weeks and again at 32-33 weeks of gestation. Only cases liveborn beyond 34 weeks of gestation and with postnatal follow-up available until discharge from the hospital were included. Regression analysis was used to examine the effect on postnatal survival of O/E LHR, gestational age at delivery, side of the diaphragmatic hernia and intrathoracic position of the liver. Wilcoxon rank test for paired samples was used to compare median O/E LHR at 22-23 weeks and 32-33 weeks, in babies who survived and in those who died. Receiver-operating characteristics (ROC) curves were constructed for the prediction of survival by O/E LHR at 22-23 weeks and at 32-33 weeks. RESULTS: In total, 53 pairs of measurements could be assessed. Univariate logistic regression analysis demonstrated that significant predictors of survival were the presence or absence of intrathoracic herniation of the liver, the O/E LHR at 22-23 weeks and the O/E LHR at 32-33 weeks of gestation. Multivariate logistic regression analysis demonstrated that only O/E LHR at 22-23 weeks or 32-33 weeks provided significant independent prediction of survival. The median O/E LHR at 22-23 weeks was not significantly different from that at 32-23 weeks either in survivors or in babies that subsequently died in the neonatal period (P = 0.25 and P = 0.09, respectively). The area under the ROC curve for prediction of postnatal survival from the O/E LHR at 22-23 weeks was 0.789 (P < 0.001) and that for prediction from the O/E LHR at 32-33 weeks was 0.842 (P < 0.001). CONCLUSIONS: In isolated diaphragmatic hernia, O/E LHR measurement at 22-23 weeks as well as at 32-33 weeks provides useful independent prediction of subsequent survival. The prediction of postnatal survival using O/E LHR is independent of the timing of assessment. Copyright (c) 2007 ISUOG. Published by John Wiley & Sons, Ltd.

Author information

Author/s: Jani, J (J); Nicolaides, K H (KH); Benachi, A (A); Moreno, O (O); Favre, R (R); Gratacos, E (E); Deprest, J (J);

Affiliation: Fetal Medicine Units of University Hospital Gasthuisberg, Leuven, Belgium.

Journal and publication information

Publication Type: Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't

Journal: Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology (Ultrasound Obstet Gynecol), published in England. (Language: eng)

Reference: 2008-Jan; vol 31 (issue 1) : pp 37-40

Dates: Created 2007/12/27; Completed 2008/05/19;

PMID: 18069722, status: MEDLINE (last retrieval date: 2/18/2009, IMS Date: )

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

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MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Cephalometry - methods Female Gestational Age Head - ultrasonography Hernia, Diaphragmatic - ultrasonography Humans Infant, Newborn Lung - ultrasonography

Male Predictive Value of Tests Pregnancy Pregnancy Outcome Pregnancy Trimester, Third Retrospective Studies Survival Analysis Ultrasonography, Prenatal - methods

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