title: The lung-to-thorax transverse area ratio at term and near term correlates with survival in isolated congenital diaphragmatic hernia.
abstract: OBJECTIVE
  The purpose of this study was to determine how well liver position, the lung area-to-head circumference (L/H) ratio, and the lung-to-thorax transverse area (L/T) ratio predicted the need for extra-corporeal membrane oxygenation (ECMO) and survival in fetuses with isolated congenital diaphragmatic hernia (CDH).
  
  
  METHODS
  Antenatal records of 25 fetuses with isolated left-sided CDH who were born by cesarean delivery under fetal stabilization at this institution were reviewed. The latest determinations of the L/H and L/T ratios before birth (between 34 and 38 weeks' gestation) were compared on the basis of the cutoff points for mortality: less than 1.0 versus 1.0 or greater for the L/H ratio and 0.08 or less versus greater than 0.08 for the L/T ratio. Outcome measures assessed were survival (discharge to home) and the need for ECMO.
  
  
  RESULTS
  Overall survival was 64% (16/25). Postnatal survival in fetuses with an L/T ratio of 0.08 or less was statistically lower than in those with an L/T ratio of greater than 0.08 (33% versus 81%; P = .0308). The percentage requiring ECMO in the group with an L/T ratio of 0.08 or less was also higher than that of the group with an L/T ratio of greater than 0.08, but the difference was not statistically significant (67% versus 25%; P = .0872). Neither the L/H ratio nor herniation of the fetal liver into the chest affected survival or the need for ECMO.
  
  
  CONCLUSIONS
  In fetuses with isolated CDH at term or near term, the L/T ratio may be a better predictor of outcome than the L/H ratio or liver herniation.
authors.affiliation: Department of Obstetrics and Gynecology, Kyushu University, Maidashi 3-1-1, Higashi-ku, Fukuoka 812, Japan. tsuki@med.kyushu-u.ac.jp
authors.forename: Kiyomi
authors.initials: K
authors.lastname: Tsukimori
authors.forename: Kouji
authors.initials: K
authors.lastname: Masumoto
authors.forename: Seiichi
authors.initials: S
authors.lastname: Morokuma
authors.forename: Takazumi
authors.initials: T
authors.lastname: Yoshimura
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Taguchi
authors.forename: Toshiro
authors.initials: T
authors.lastname: Hara
authors.forename: Yoshiro
authors.initials: Y
authors.lastname: Sakaguchi
authors.forename: Shosuke
authors.initials: S
authors.lastname: Takahashi
authors.forename: Norio
authors.initials: N
authors.lastname: Wake
authors.forename: Sachiyo
authors.initials: S
authors.lastname: Suita
mesh_terms: D019412:Anatomy, Cross-Sectional; D002585:Cesarean Section; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D047109:Fetal Development; D005315:Fetal Diseases / Q000000981:diagnostic imaging*; D005325:Fetal Organ Maturity; D005328:Fetal Viability; D005865:Gestational Age; D006257:Head / Q000000981:diagnostic imaging / Q000196:embryology; D006548:Hernia, Diaphragmatic / Q000000981:diagnostic imaging*; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D007231:Infant, Newborn; D008099:Liver / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000196:embryology; D008168:Lung / Q000000981:diagnostic imaging / Q000196:embryology*; D010547:Persistent Fetal Circulation Syndrome / Q000209:etiology; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D015996:Survival Rate; D013909:Thorax / Q000000981:diagnostic imaging / Q000196:embryology*; D016216:Ultrasonography, Prenatal