title: Liver position and lung-to-head ratio for prediction of extracorporeal membrane oxygenation and survival in isolated left congenital diaphragmatic hernia.
abstract: The purpose of this study was to determine the ability of liver position and lung-to-head ratio to predict outcome in isolated left congenital diaphragmatic hernia.
  
  
  
  We reviewed prenatal studies and postnatal outcomes of congenital diaphragmatic hernia between January 1996 and January 2006.
  
  
  
  Eighty-nine patients received prenatal and postnatal care at 1 institution. In fetuses with liver up, extracorporeal membrane oxygenation was required in 39 of 49 fetuses (80%), compared with 10 of 40 fetuses (25%) for those with liver down (P < .0001). Overall survival rate was 45%, compared with 93% for those with liver down (P < .00005). Low lung-to-head ratio (<1.0) predicted increased incidence of extracorporeal membrane oxygenation (75%; P = .036) and lower survival (35%; P = .0003). However, when measured at <24 weeks of gestation, lung-to-head ratio was not predictive of outcome (extracorporeal membrane oxygenation, P = .108; survival, P = .150); liver position remained highly predictive (extracorporeal membrane oxygenation, P = .006; survival, P = .001).
  
  
  
  Liver position is the best prenatal predictor of outcome in isolated left congenital diaphragmatic hernia. Lung-to-head ratio alone should not be used to counsel families regarding mid gestational management choices.
authors: Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
authors: Holly L
authors: HL
authors: Hedrick
authors: Enrico
authors: E
authors: Danzer
authors: Aziz M
authors: AM
authors: Merchant
authors: Michael W
authors: MW
authors: Bebbington
authors: Huaqing
authors: H
authors: Zhao
authors: Alan W
authors: AW
authors: Flake
authors: Mark P
authors: MP
authors: Johnson
authors: Kenneth W
authors: KW
authors: Liechty
authors: Lori J
authors: LJ
authors: Howell
authors: R Douglas
authors: RD
authors: Wilson
authors: N Scott
authors: NS
authors: Adzick
mesh_terms: D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D006548:Hernia, Diaphragmatic / Q000000981:diagnostic imaging / Q000378:metabolism / Q000628:therapy; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D008099:Liver / Q000196:embryology* / Q000378:metabolism; D008168:Lung / Q000196:embryology* / Q000378:metabolism; D008279:Magnetic Resonance Imaging; D011237:Predictive Value of Tests; D011247:Pregnancy; D012121:Respiration, Artificial; D012189:Retrospective Studies; D016216:Ultrasonography, Prenatal