Three-dimensional ultrasonographic assessment of fetal lung volume as prognostic factor in isolated congenital diaphragmatic hernia.
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.
Ruano
Rodrigo
R
Maternité, Hôpital Necker-Enfants Malades, Université Paris V et AP-HP, France.
Benachi
Alexandra
A
Joubin
Laurence
L
Aubry
Marie-Cécile
MC
Thalabard
Jean-Christophe
JC
Dumez
Yves
Y
Dommergues
Marc
M
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