AAP PapersLate gestation fetal magnetic resonance imaging–derived total lung volume predicts postnatal survival and need for extracorporeal membrane oxygenation support in isolated congenital diaphragmatic hernia
Section snippets
Patient demographics
Between 2006 and 2009, there were 136 consecutive patients who were evaluated at the Fetal Care Center of Cincinnati at Cincinnati Children's Hospital for CDH. Patients were excluded from the study if there was an associated congenital cardiac defect or chromosomal abnormality. Of the 136 patients with a diagnosis of CDH evaluated during the study period, 44 had an isolated CDH that had a late gestation (32-34 weeks) fetal MRI for total lung volume (TLV) and who also were treated on the CDH
Study population
The study consisted of 44 consecutive patients with an isolated CDH who met selection criteria. The patient demographics are listed in Table 1. There were 39 left CDH and 5 right CDH patients identified during the study period. The average gestational age at birth was 37 6/7 weeks (range, 34-39 5/7 weeks). Liver herniation was present in 59% of the study population. The mean TLV for the entire cohort was 27.7 ± 11.8 mL. Lung-to-head circumference ratio data were available for a subset of the
Discussion
This study demonstrates that late gestation fetal MRI–derived TLV may provide useful information for the counseling of patients who have a fetus with an isolated CDH. In this study, a clear association was observed between lower TLVs at 32 to 34 weeks gestation and the need for ECMO support and an increased postnatal mortality. These findings may have clinical benefit, especially in those patients with no previous workup or a workup from an outside facility without the capability of obtaining
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Cited by (56)
Primary contributors to gastrostomy tube placement in infants with Congenital Diaphragmatic Hernia
2021, Journal of Pediatric SurgeryA single-center observational study on congenital diaphragmatic hernia: Outcome, predictors of mortality and experience from a tertiary perinatal center in Singapore
2020, Pediatrics and NeonatologyCitation Excerpt :There is limited outcome data on CDH in the Southeast Asian region.10–12 Various studies have reported antenatal prognostic markers for CDH, such as the association between congenital abnormalities,13 degree of liver herniation,14 lung-head ratio,15 and fetal MRI of lung volume16 as predictors for survival of live-born infants with CDH. As for postnatal prognostic markers, the score for neonatal acute physiology version II (SNAP-II),17 the Wilford Hall/Santa Rosa predictive formula (WHSRpf),18 the Congenital Diaphragmatic Hernia Study Group (CDHSG) model,19 the oxygenation index,20 and the size of the diaphragmatic defect as assessed during surgery,12 have been reported to affect outcome.
Prediction tools in congenital diaphragmatic hernia
2020, Seminars in PerinatologyEvaluation of Lung Injury in Infants with Congenital Diaphragmatic Hernia
2019, Journal of Pediatric SurgeryPrognostic value of the oxygenation index to predict survival and timing of surgery in infants with congenital diaphragmatic hernia
2019, Journal of Pediatric Surgery
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Current address, Division of Pediatric Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX.