title: Prediction of chronic lung disease, survival and need for ECMO therapy in infants with congenital diaphragmatic hernia: additional value of fetal MRI measurements?
abstract: BACKGROUND
  The lung-to-head ratio (LHR), measured by ultrasound, and the fetal lung volume (FLV), measured by MRI, are both used to predict survival and need for extra corporeal membrane oxygenation (ECMO) in infants with congenital diaphragmatic hernia (CDH). The aim of this study is to determine whether MRI measurements of the FLV, in addition to standard ultrasound measurements of the LHR, give better prediction of chronic lung disease, mortality by day 28 and need for ECMO.
  
  
  METHODS
  Patients with unilateral isolated CDH born between January 2002 and December 2008 were eligible for inclusion. LHR and FLV were expressed as observed-to-expected values (O/E LHR and O/E FLV). Univariate and multivariate analyses were performed. Receiver operating characteristic curves were constructed and areas under the curve (AUC) were calculated to determine predictive values.
  
  
  RESULTS
  90 patients were included in the analysis. Combined measurement of the O/E LHR and O/E FLV gave a slightly better prediction of chronic lung disease (AUC=0.83 and AUC=0.87) and need for ECMO therapy (AUC=0.77 and AUC=0.81) than standard ultrasound measurements of the O/E LHR alone. Combined measurement of the O/E LHR and O/E FLV did not improve prediction of early mortality (AUC=0.90) compared to measurement of the O/E LHR alone (AUC=0.89). An intrathoracal position of the liver was independently associated with a higher risk of early mortality (p<0.001), chronic lung disease (p=0.007) and need for ECMO therapy (p=0.001).
  
  
  CONCLUSIONS
  Chronic lung disease and need for ECMO therapy are slightly better predicted by combined measurement of the O/E LHR and the O/E FLV. Early mortality is very well predicted by measurement of the O/E LHR alone.
  
  
  CONCLUSIONS
  Clinical relevance of additional MRI measurements may be debated.
authors: Universitätsmedizin Mannheim, Department of Paediatric Intensive Care Medicine, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany. Thomas.Schaible@umm.de
authors: T
authors: T
authors: Schaible
authors: K A
authors: KA
authors: Büsing
authors: J F
authors: JF
authors: Felix
authors: W C J
authors: WC
authors: Hop
authors: K
authors: K
authors: Zahn
authors: L
authors: L
authors: Wessel
authors: J
authors: J
authors: Siemer
authors: K W
authors: KW
authors: Neff
authors: D
authors: D
authors: Tibboel
authors: I
authors: I
authors: Reiss
authors: L
authors: L
authors: van den Hout
mesh_terms: D015897:Comorbidity; D015199:Extracorporeal Membrane Oxygenation / Q000401:mortality*; D005858:Germany / Q000453:epidemiology; D006548:Hernia, Diaphragmatic / Q000401:mortality / Q000628:therapy; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D007231:Infant, Newborn; D055370:Lung Injury / Q000151:congenital / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D011296:Prenatal Diagnosis / Q000706:statistics & numerical data*; D015995:Prevalence; D011379:Prognosis; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome