Kazunori Masahata1, Masaya Yamoto2, Satoshi Umeda3, Kouji Nagata4, Keita Terui5, Makoto Fujii6, Masayuki Shiraishi7, Masahiro Hayakawa8, Shoichiro Amari9, Kouji Masumoto10, Tadaharu Okazaki11, Noboru Inamura12, Katsuaki Toyoshima13, Yuki Koike14, Taizo Furukawa15, Yuta Yazaki16, Akiko Yokoi17, Masayuki Endo18, Yuko Tazuke19, Hiroomi Okuyama19, Noriaki Usui3. 1. Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Japan. masahata@pedsurg.med.osaka-u.ac.jp. 2. Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan. 3. Department of Pediatric Surgery, Osaka Women's and Children's Hospital, Izumi, Japan. 4. Department of Pediatric Surgery, Kyushu University, Fukuoka, Japan. 5. Department of Pediatric Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan. 6. Department of Health Science, Graduate School of Medicine, Osaka University, Suita, Japan. 7. Osaka University Library, Suita, Japan. 8. Division of Neonatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Japan. 9. Division of Neonatology, National Center for Child Health and Development, Tokyo, Japan. 10. Department of Pediatric Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan. 11. Department of Pediatric Surgery, Juntendo University Urayasu Hospital, Urayasu, Japan. 12. Department of Pediatrics, Kindai University Faculty of Medicine, Osaka-Sayama, Japan. 13. Departments of Neonatology, Kanagawa Children's Medical Center, Yokohama, Japan. 14. Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Japan. 15. Department of Pediatric Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan. 16. Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan. 17. Departments of Pediatric Surgery, Kobe Children's Medical Center, Kobe, Japan. 18. Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Suita, Japan. 19. Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Japan.
Abstract
PURPOSE: This study aimed to evaluate prenatal predictors of mortality in fetuses with congenital diaphragmatic hernia (CDH). METHODS: A systematic literature search was performed to identify relevant observational studies that evaluated the ability of lung-to-head ratio (LHR), observed-to-expected LHR (o/e-LHR), observed-to-expected total fetal lung volume (o/e-TFLV), lung-to-thorax transverse area ratio (L/T ratio), intrathoracic herniation of the liver and the stomach, and side of diaphragmatic hernia, using a threshold for the prediction of mortality in fetuses with CDH. Study quality was assessed using the QUADAS-2 tool. Hierarchical summary receiver operating characteristic curves were constructed. RESULTS: A total of 50 articles were included in this meta-analysis. The QUADAS-2 tool identified a high risk of bias in more than one domain scored in all parameters. Among those parameters, the diagnostic odds ratio of mortality with o/e-LHR < 25%, o/e-TFLV < 25%, and L/T ratio < 0.08 were 11.98 [95% confidence interval (CI) 4.65-30.89], 11.14 (95% CI 5.19-23.89), and 10.28 (95% CI 3.38-31.31), respectively. The predictive values for mortality were similar between the presence of liver herniation and retrocardiac fetal stomach position. CONCLUSIONS: This systematic review suggests that o/e-LHR, o/e-TFLV, and L/T ratio are equally good predictors of neonatal mortality in fetuses with isolated CDH.
PURPOSE: This study aimed to evaluate prenatal predictors of mortality in fetuses with congenital diaphragmatic hernia (CDH). METHODS: A systematic literature search was performed to identify relevant observational studies that evaluated the ability of lung-to-head ratio (LHR), observed-to-expected LHR (o/e-LHR), observed-to-expected total fetal lung volume (o/e-TFLV), lung-to-thorax transverse area ratio (L/T ratio), intrathoracic herniation of the liver and the stomach, and side of diaphragmatic hernia, using a threshold for the prediction of mortality in fetuses with CDH. Study quality was assessed using the QUADAS-2 tool. Hierarchical summary receiver operating characteristic curves were constructed. RESULTS: A total of 50 articles were included in this meta-analysis. The QUADAS-2 tool identified a high risk of bias in more than one domain scored in all parameters. Among those parameters, the diagnostic odds ratio of mortality with o/e-LHR < 25%, o/e-TFLV < 25%, and L/T ratio < 0.08 were 11.98 [95% confidence interval (CI) 4.65-30.89], 11.14 (95% CI 5.19-23.89), and 10.28 (95% CI 3.38-31.31), respectively. The predictive values for mortality were similar between the presence of liver herniation and retrocardiac fetal stomach position. CONCLUSIONS: This systematic review suggests that o/e-LHR, o/e-TFLV, and L/T ratio are equally good predictors of neonatal mortality in fetuses with isolated CDH.
Authors: Holly L Hedrick; Enrico Danzer; Aziz M Merchant; Michael W Bebbington; Huaqing Zhao; Alan W Flake; Mark P Johnson; Kenneth W Liechty; Lori J Howell; R Douglas Wilson; N Scott Adzick Journal: Am J Obstet Gynecol Date: 2007-10 Impact factor: 8.661
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Authors: M Dommergues; C Louis-Sylvestre; L Mandelbrot; J F Oury; M Herlicoviez; G Body; M Gamerre; Y Dumez Journal: Am J Obstet Gynecol Date: 1996-04 Impact factor: 8.661
Authors: C T Albanese; J Lopoo; R B Goldstein; R A Filly; V A Feldstein; P W Calen; R W Jennings; J A Farrell; M R Harrison Journal: Prenat Diagn Date: 1998-11 Impact factor: 3.050
Authors: Jan A Deprest; Kypros H Nicolaides; Alexandra Benachi; Eduard Gratacos; Greg Ryan; Nicola Persico; Haruhiko Sago; Anthony Johnson; Mirosław Wielgoś; Christoph Berg; Ben Van Calster; Francesca M Russo Journal: N Engl J Med Date: 2021-06-08 Impact factor: 176.079