Prediction of mortality and need for neonatal extracorporeal membrane oxygenation in fetuses with congenital diaphragmatic hernia: logistic regression analysis based on MRI fetal lung volume measurements.
OBJECTIVE
The purpose of this study was to use logistic regression analysis of prenatal MRI fetal lung volume measurements to calculate mortality and the need for extracorporeal membrane oxygenation (ECMO) therapy among fetuses with congenital diaphragmatic hernia (CDH).


METHODS
The fetal lung volume measurements of 65 fetuses with CDH were obtained between 32 and 34 weeks' gestation by means of MRI performed with multiplanar T2-weighted HASTE and true fast imaging with steady-state precession sequences. Logistic regression analysis was used to assess the prognostic value of the fetal lung volume measurements for prenatal prediction of fetal survival and need for neonatal ECMO.


RESULTS
Fetal lung volume was a highly significant predictor of survival (p < 0.0001) and neonatal ECMO requirement (p = 0.0006). The mortality was 84% and the ECMO requirement 80% among fetuses with a lung volume of 5 mL. The mortality was 0.4% and the ECMO requirement 20% among patients with a fetal lung volume of 30 mL.


CONCLUSIONS
Logistic regression analysis of MRI fetal lung volume measurements is highly valuable in predicting mortality among neonates with CDH, and it may help to estimate the need for neonatal ECMO. The method is feasible for facilitating parental guidance and may help in choosing postnatal therapeutic options, including ECMO therapy.
Neff
K Wolfgang
KW
Department of Clinical Radiology, University Hospital Mannheim, University of Heidelberg, Theodor Kutzer Ufer 1-3, 68167 Mannheim, Germany. wolfgang.neff@rad.ma.uni-heidelberg.de
Kilian
A Kristina
AK
Schaible
Thomas
T
Schütz
Eva-Maria
EM
Büsing
Karen A
KA
D015199:Extracorporeal Membrane Oxygenation / Q000401:mortality*; D005260:Female; D005323:Fetal Monitoring / Q000706:statistics & numerical data*; D005858:Germany / Q000453:epidemiology; D006548:Hernia, Diaphragmatic / Q000175:diagnosis / Q000401:mortality* / Q000517:prevention & control*; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000706:statistics & numerical data; D016015:Logistic Models; D008279:Magnetic Resonance Imaging / Q000706:statistics & numerical data*; D008297:Male; D015995:Prevalence; D011379:Prognosis; D012044:Regression Analysis; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D013990:Tidal Volume