AAP Papers
Late gestation fetal magnetic resonance imaging–derived total lung volume predicts postnatal survival and need for extracorporeal membrane oxygenation support in isolated congenital diaphragmatic hernia

https://doi.org/10.1016/j.jpedsurg.2011.03.046Get rights and content

Abstract

Purpose

Magnetic resonance imaging (MRI) has been used as an imaging modality to assess pulmonary hypoplasia in congenital diaphragmatic hernias (CDHs). The objective of this study was to determine if there is a correlation between late gestational fetal MRI–derived total lung volumes (TLVs) and CDH outcomes.

Methods

From 2006 to 2009, 44 patients met criteria of an isolated CDH with a late gestational MRI evaluation. The prenatal TLV (in milliliters) was obtained between 32 and 34 weeks gestation. The measured study outcomes included survival, need for extracorporeal membrane oxygenation (ECMO), and length of stay.

Results

There were 39 left and 5 right CDH patients. The average TLV was significantly lower for nonsurvivors (P = .01), and there was a significant association between lower TLV and the need for ECMO (P = .0001). When stratified by TLV, patients with a TLV of greater than 40 mL had a 90% survival vs 35% survival for a TLV of less than 20 mL. Furthermore, patients with a TLV greater than 40 mL had a lower rate of ECMO use (10%) than patients with a TLV of less than 20 mL (86%). Shorter length of stay was found to correlate with increasing TLV (P = .022).

Conclusion

Late gestation fetal MRI–derived TLV significantly correlates with postnatal survival and need for ECMO. Fetal MRI may be useful for the evaluation of patients who present late in gestation with a CDH.

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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  • A single-center observational study on congenital diaphragmatic hernia: Outcome, predictors of mortality and experience from a tertiary perinatal center in Singapore

    2020, Pediatrics and Neonatology
    Citation 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.

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1

Current address, Division of Pediatric Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX.

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