The lung-to-thorax transverse area ratio at term and near term correlates with survival in isolated congenital diaphragmatic hernia.
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.
Tsukimori
Kiyomi
K
Department of Obstetrics and Gynecology, Kyushu University, Maidashi 3-1-1, Higashi-ku, Fukuoka 812, Japan. tsuki@med.kyushu-u.ac.jp
Masumoto
Kouji
K
Morokuma
Seiichi
S
Yoshimura
Takazumi
T
Taguchi
Tomoaki
T
Hara
Toshiro
T
Sakaguchi
Yoshiro
Y
Takahashi
Shosuke
S
Wake
Norio
N
Suita
Sachiyo
S
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