title: Three-dimensional ultrasonographic assessment of fetal lung volume as prognostic factor in isolated congenital diaphragmatic hernia.
abstract: OBJECTIVE
  To evaluate the potential of three-dimensional ultrasound to predict outcome in congenital diaphragmatic hernia.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  Tertiary care centre.
  
  
  METHODS
  Twelve cases of isolated congenital diaphragmatic hernia (11 left-sided, 1 right-sided) and 109 controls.
  
  
  METHODS
  Fetal lung volume was assessed by three-dimensional ultrasound using the technique of rotation of the multiplanar imaging. In the control fetuses, a logistic transformation was performed to correlate fetal lung volume with gestational age, and the confidence interval was obtained with a bootstrap resampling. A mathematical equation was then obtained allowing calculation of the expected fetal lung volume as a function of gestational age. In fetuses with congenital diaphragmatic hernia, the observed/expected lung volume ratio was compared with postnatal outcome.
  
  
  METHODS
  Neonatal mortality and pulmonary hypoplasia, which was defined as lung/body weight ratios less than 0.012.
  
  
  RESULTS
  The expected fetal lung volume was derived from the mathematical equation: Fetal lung volume (mL) = exp (4.72/(1 + exp ((20.32 - gestational age in weeks)/6.05))). The observed/expected fetal lung volume ratio was significantly lower in the congenital diaphragmatic hernia group (median: 0.34, range: 0.16-0.66), than in the control group (median: 1.02, range: 0.62-1.97, P < 0.0001). The distribution of this ratio was significantly downshifted in the infants with congenital diaphragmatic hernia who died (median: 0.19, range: 0.18-0.66) compared with survivors (median: 0.44, range: 0.36-0.66, P= 0.04). The observed/expected fetal lung volume ratio was also correlated with the postmortem lung/body weight ratio.
  
  
  CONCLUSIONS
  In isolated congenital diaphragmatic hernia, fetal lung volume measurement by three-dimensional ultrasound is a potential predictor for pulmonary hypoplasia and postnatal outcome.
authors.affiliation: Maternité, Hôpital Necker-Enfants Malades, Université Paris V et AP-HP, France.
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Ruano
authors.forename: Alexandra
authors.initials: A
authors.lastname: Benachi
authors.forename: Laurence
authors.initials: L
authors.lastname: Joubin
authors.forename: Marie-Cécile
authors.initials: MC
authors.lastname: Aubry
authors.forename: Jean-Christophe
authors.initials: JC
authors.lastname: Thalabard
authors.forename: Yves
authors.initials: Y
authors.lastname: Dumez
authors.forename: Marc
authors.initials: M
authors.lastname: Dommergues
mesh_terms: D005260:Female; D005865:Gestational Age; D006548:Hernia, Diaphragmatic / Q000000981:diagnostic imaging; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D007231:Infant, Newborn; D008168:Lung / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000196:embryology*; D008176:Lung Volume Measurements; D011247:Pregnancy; D011263:Pregnancy Trimester, Third; D011379:Prognosis; D011446:Prospective Studies; D016216:Ultrasonography, Prenatal / Q000379:methods