BACKGROUND: Fetuses with congenital diaphragmatic hernia (CDH) are at risk of death from pulmonary hypoplasia at birth. OBJECTIVE: To determine the value of prenatal imaging parameters for predicting lethal pulmonary hypoplasia in fetuses with CDH. SEARCH STRATEGY: Relevant papers were identified by searching MEDLINE (1966-2008), EMBASE (1988-2008) and the Cochrane Library (2008 issue 3). SELECTION CRITERIA: Selected studies examined diagnostic tests for the prenatal prediction of lethal pulmonary hypoplasia in fetuses with CDH. The primary outcome measure was perinatal survival. RESULTS: Twenty-one studies fulfilled the entry criteria, of which six examined entirely unique heterogeneous parameters and the remaining 15 examined lung-head ratios (LHR) and/or the presence of liver in the fetal thorax. The strongest association was that of LHR > or = 0.6 compared to <0.6 (OR: 17.02; 95% CI: 2.10-137.89), although more clinically relevant was that of LHR >1.0 (OR: 5.07; 95% CI: 2.94-8.74). The finding of liver in the fetal chest was a poor prognostic feature (survival OR: 0.32; 95% CI: 0.21-0.49). CONCLUSION: In CDH, LHR and the presence of liver in the fetal thorax may be a useful predictive indicator of perinatal survival. Future usage of developing techniques needs careful evaluation prior to usage to guide therapy.
BACKGROUND: Fetuses with congenital diaphragmatic hernia (CDH) are at risk of death from pulmonary hypoplasia at birth. OBJECTIVE: To determine the value of prenatal imaging parameters for predicting lethal pulmonary hypoplasia in fetuses with CDH. SEARCH STRATEGY: Relevant papers were identified by searching MEDLINE (1966-2008), EMBASE (1988-2008) and the Cochrane Library (2008 issue 3). SELECTION CRITERIA: Selected studies examined diagnostic tests for the prenatal prediction of lethal pulmonary hypoplasia in fetuses with CDH. The primary outcome measure was perinatal survival. RESULTS: Twenty-one studies fulfilled the entry criteria, of which six examined entirely unique heterogeneous parameters and the remaining 15 examined lung-head ratios (LHR) and/or the presence of liver in the fetal thorax. The strongest association was that of LHR > or = 0.6 compared to <0.6 (OR: 17.02; 95% CI: 2.10-137.89), although more clinically relevant was that of LHR >1.0 (OR: 5.07; 95% CI: 2.94-8.74). The finding of liver in the fetal chest was a poor prognostic feature (survival OR: 0.32; 95% CI: 0.21-0.49). CONCLUSION: In CDH, LHR and the presence of liver in the fetal thorax may be a useful predictive indicator of perinatal survival. Future usage of developing techniques needs careful evaluation prior to usage to guide therapy.
Authors: Pramod Puligandla; Erik Skarsgard; Martin Offringa; Ian Adatia; Robert Baird; Michelle Bailey; Mary Brindle; Priscilla Chiu; Arthur Cogswell; Shyamala Dakshinamurti; Hélène Flageole; Richard Keijzer; Douglas McMillan; Titilayo Oluyomi-Obi; Thomas Pennaforte; Thérèse Perreault; Bruno Piedboeuf; S. Patricia Riley; Greg Ryan; Anne Synnes; Michael Traynor Journal: CMAJ Date: 2018-01-29 Impact factor: 8.262
Authors: Leslie A Lusk; Katherine C Wai; Anita J Moon-Grady; Amaya M Basta; Roy Filly; Roberta L Keller Journal: Am J Obstet Gynecol Date: 2015-03-19 Impact factor: 8.661
Authors: Arin L Madenci; Anna R Sjogren; Marjorie C Treadwell; Maria F Ladino-Torres; Robert A Drongowski; Jeannie Kreutzman; Steven W Bruch; George B Mychaliska Journal: J Pediatr Surg Date: 2013-06 Impact factor: 2.545