Robin T Petroze1, Natasha G Caminsky1, Josée Trebichavsky2, Sarah Bouchard2, Annie Le-Nguyen3, Jean-Martin Laberge1, Sherif Emil1, Pramod S Puligandla4. 1. Division of Pediatric General and Thoracic Surgery, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada. 2. Division of Pediatric Surgery, CHU Sainte-Justine, Montreal, QC, Canada. 3. Department of General Surgery, University of Montreal, Montreal, QC, Canada. 4. Division of Pediatric General and Thoracic Surgery, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada. Electronic address: pramod.puligandla@mcgill.ca.
Abstract
PURPOSE: Effective antenatal counseling in congenital diaphragmatic hernia (CDH) relies on proper measurement of prognostic indices. This quality initiative audited the accuracy of prenatal imaging with postnatal outcomes at two tertiary pediatric referral centers. METHODS: Prenatal lung-head ratio (LHR) and total fetal lung volume (TFLV) for CDH patients treated between 2006 and 2017 were retrieved. Study inclusion required at least one LHR or TFLV measurement between 24 and 32 weeks gestational age. Postnatal outcomes [mortality, extracorporeal life support (ECLS) need, patch repair, persistent pulmonary hypertension, oxygen requirement at 28 days] were abstracted from the Canadian Pediatric Surgery Network (CAPSNet) database and local chart review. Univariate and descriptive analyses were conducted. RESULTS: Eighty-two of 121 eligible CDH patients (68%) were included. Overall mortality, ECLS rates, and patch repair were 33%, 12.5%, and 45%, respectively. Lower LHR values correlated with increased rates of each outcome and persisted despite multiple measurements. Values obtained were higher than those in published schemata. LHR values >45% were most associated with survival, avoidance of ECLS, and primary repair. TFLV values only correlated with mortality and patch repair. CONCLUSIONS: This audit confirms that LHR and TFLV values predict CDH outcomes. However, absolute values obtained require careful interpretation and internal review. LEVEL OF EVIDENCE: IV.
PURPOSE: Effective antenatal counseling in congenital diaphragmatic hernia (CDH) relies on proper measurement of prognostic indices. This quality initiative audited the accuracy of prenatal imaging with postnatal outcomes at two tertiary pediatric referral centers. METHODS: Prenatal lung-head ratio (LHR) and total fetal lung volume (TFLV) for CDHpatients treated between 2006 and 2017 were retrieved. Study inclusion required at least one LHR or TFLV measurement between 24 and 32 weeks gestational age. Postnatal outcomes [mortality, extracorporeal life support (ECLS) need, patch repair, persistent pulmonary hypertension, oxygen requirement at 28 days] were abstracted from the Canadian Pediatric Surgery Network (CAPSNet) database and local chart review. Univariate and descriptive analyses were conducted. RESULTS: Eighty-two of 121 eligible CDHpatients (68%) were included. Overall mortality, ECLS rates, and patch repair were 33%, 12.5%, and 45%, respectively. Lower LHR values correlated with increased rates of each outcome and persisted despite multiple measurements. Values obtained were higher than those in published schemata. LHR values >45% were most associated with survival, avoidance of ECLS, and primary repair. TFLV values only correlated with mortality and patch repair. CONCLUSIONS: This audit confirms that LHR and TFLV values predict CDH outcomes. However, absolute values obtained require careful interpretation and internal review. LEVEL OF EVIDENCE: IV.
Authors: Ruth B Seabrook; Theresa R Grover; Natalie Rintoul; Mark Weems; Sarah Keene; Beverly Brozanski; Robert DiGeronimo; Beth Haberman; Holly Hedrick; Jason Gien; Noorjahan Ali; Rachel Chapman; John Daniel; H Allen Harrison; Yvette Johnson; Nicolas F M Porta; Michael Uhing; Isabella Zaniletti; Karna Murthy Journal: J Perinatol Date: 2021-03-01 Impact factor: 2.521
Authors: Joseph Davidson; Alena Uus; Alexia Egloff; Milou van Poppel; Jacqueline Matthew; Johannes Steinweg; Maria Deprez; Michael Aertsen; Jan Deprest; Mary Rutherford Journal: Prenat Diagn Date: 2022-03-15 Impact factor: 3.242