title: Observed to expected lung area to head circumference ratio in the prediction of survival in fetuses with isolated diaphragmatic hernia.
abstract: OBJECTIVE
  To assess the value of antenatally determined observed to expected fetal lung area to head circumference ratio (LHR) in the prediction of postnatal survival in isolated, congenital diaphragmatic hernia (CDH).
  
  
  METHODS
  Two groups of fetuses were examined. The first group included 650 normal fetuses at 12-32 weeks' gestation, and the data collected were used to establish a normal range of observed to expected LHR with gestational age. The second group included the data of a retrospective multicenter study of 354 fetuses with isolated CDH in which the LHR was measured on one occasion at 18-38 weeks' gestation. The patients were divided into those with left-sided CDH with and without intrathoracic herniation of the liver and right-sided CDH. Regression analysis was used to determine the significant predictors of postnatal survival.
  
  
  RESULTS
  In both the normal fetuses and those with CDH the LHR increased but the observed to expected LHR did not change significantly with gestational age. In normal fetuses the mean observed to expected LHR in the left lung was 100% (95% CI, 61-139%) and in the right lung it was 100% (95% CI, 67-133%). In fetuses with CDH the mean observed to expected LHR was 39% (range 7-79%). Regression analysis demonstrated that significant predictors of survival were the observed to expected LHR (odds ratio (OR) 1.09, 95% CI, 1.06-1.12), side of CDH (left side OR 11.14, 95% CI, 3.41-36.39) and gestational age at delivery (OR 1.18, 95% CI, 1.02-1.36).
  
  
  CONCLUSIONS
  In CDH, the LHR increases while observed to expected LHR is independent of gestational age. In fetuses with both left- and right-sided CDH, measurement of the observed to expected LHR provides a useful prediction of subsequent survival.
authors.affiliation: Fetal Medicine and Treatment Units, University Hospital Gasthuisberg, Leuven, Belgium.
authors.forename: J
authors.initials: J
authors.lastname: Jani
authors.forename: K H
authors.initials: KH
authors.lastname: Nicolaides
authors.forename: R L
authors.initials: RL
authors.lastname: Keller
authors.forename: A
authors.initials: A
authors.lastname: Benachi
authors.forename: C F A
authors.initials: CF
authors.lastname: Peralta
authors.forename: R
authors.initials: R
authors.lastname: Favre
authors.forename: O
authors.initials: O
authors.lastname: Moreno
authors.forename: D
authors.initials: D
authors.lastname: Tibboel
authors.forename: S
authors.initials: S
authors.lastname: Lipitz
authors.forename: A
authors.initials: A
authors.lastname: Eggink
authors.forename: P
authors.initials: P
authors.lastname: Vaast
authors.forename: K
authors.initials: K
authors.lastname: Allegaert
authors.forename: M
authors.initials: M
authors.lastname: Harrison
authors.forename: J
authors.initials: J
authors.lastname: Deprest
mesh_terms: D016022:Case-Control Studies; D005260:Female; D005865:Gestational Age; D006257:Head / Q000000981:diagnostic imaging / Q000196:embryology*; D006548:Hernia, Diaphragmatic / Q000000981:diagnostic imaging / Q000196:embryology; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D007231:Infant, Newborn; D008168:Lung / Q000000981:diagnostic imaging / Q000196:embryology*; D011237:Predictive Value of Tests; D011247:Pregnancy; D011296:Prenatal Diagnosis / Q000379:methods*; D012372:ROC Curve; D016019:Survival Analysis; D016216:Ultrasonography, Prenatal / Q000379:methods