title: Congenital diaphragmatic hernia: lung-to-head ratio and lung volume for prediction of outcome.
abstract: OBJECTIVE
  The purpose of this study was to evaluate observed/expected (O/E) lung-to-head ratio (LHR) by ultrasound (US) and total fetal lung volume (TFLV) by magnetic resonance imaging as neonatal outcome predictors in isolated fetal congenital diaphragmatic hernia (CDH).
  
  
  METHODS
  We conducted a retrospective study of 72 fetuses with isolated CDH, in whom O/E LHR and TFLV were evaluated as survival predictors.
  
  
  RESULTS
  O/E LHR on US and O/E TFLV by magnetic resonance imaging were significantly lower in newborn infants with isolated CDH who died compared with survivors (30.3 ± 8.3 vs 44.2 ± 14.2; P < .0001 for O/E LHR; 21.9 ± 6.3 vs 41.5 ± 17.6; P = .001 for O/E TFLV). Area under receiver-operator characteristics curve for survival for O/E LHR was 0.80 (95% confidence interval, 0.70-0.90). On multivariate analysis, O/E LHR predicted survival, whereas hernia side and first neonatal pH did not. For each unit increase in O/E LHR, mortality odds decreased by 11% (95% confidence interval, 4-17%).
  
  
  CONCLUSIONS
  In fetuses with isolated CDH, O/E LHR (US) independently predicts survival and may predict severity, allowing management to be optimized.
authors.affiliation: Fetal Medicine Unit, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Malikah A
authors.initials: MA
authors.lastname: Alfaraj
authors.forename: Prakesh S
authors.initials: PS
authors.lastname: Shah
authors.forename: Desmond
authors.initials: D
authors.lastname: Bohn
authors.forename: Sophia
authors.initials: S
authors.lastname: Pantazi
authors.forename: Karel
authors.initials: K
authors.lastname: O'Brien
authors.forename: Priscilla P
authors.initials: PP
authors.lastname: Chiu
authors.forename: Rose
authors.initials: R
authors.lastname: Gaiteiro
authors.forename: Greg
authors.initials: G
authors.lastname: Ryan
mesh_terms: D005260:Female; D006257:Head / Q000000981:diagnostic imaging*; D006548:Hernia, Diaphragmatic / Q000000981:diagnostic imaging / Q000401:mortality; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D007231:Infant, Newborn; D008168:Lung / Q000002:abnormalities / Q000000981:diagnostic imaging*; D008176:Lung Volume Measurements; D008279:Magnetic Resonance Imaging; D008297:Male; D009929:Organ Size; D011237:Predictive Value of Tests; D011247:Pregnancy; D011248:Pregnancy Complications / Q000000981:diagnostic imaging / Q000401:mortality; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014463:Ultrasonography