title: Prenatal lung-head ratio: threshold to predict outcome for congenital diaphragmatic hernia.
abstract: OBJECTIVE
  The literature suggests that lung-head ratio (LHR) and liver position may inconsistently predict outcome for congenital diaphragmatic hernia (CDH). We reviewed our inborn neonates with isolated left-sided CDH to determine whether these variables predicted survival and to estimate the optimal LHR threshold.
  
  
  METHODS
  Prenatal LHR and liver position were obtained from 2002 to 2009. The primary endpoint was survival.
  
  
  RESULTS
  LHR was greater in survivors after adjusting for gestational age (median 1.40 versus 0.81; p < 0.001). LHR demonstrated excellent diagnostic discrimination, with area under receiver operating characteristic (ROC) curve 0.93 (95% CI 0.86-0.99). LHR threshold of 1.0 was 83% sensitive and 91% specific in predicting survival. An optimal LHR threshold of 0.85 predicted survival with 95% sensitivity and 64% specificity, reducing false negatives (survivors with low LHR). LHR > 0.85 predicted survival after adjustment for gestational age (OR = 33.6, 95% CI = 5.4-209.5). Liver position did not predict survival.
  
  
  CONCLUSIONS
  Prenatal LHR >0.85 predicts survival for infants with isolated left-sided CDH without compromising discrimination of survivors from non-survivors. The diagnostic utility of LHR may be confounded by gestational age at measurement. Stringent LHR threshold may minimize false-negative attribution and improve utility of this measurement as predictor of survival.
authors.affiliation: Division of Pediatric Surgery, Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University Medical Center, New York, NY 10032, USA. ga2221@columbia.edu
authors.forename: Gudrun
authors.initials: G
authors.lastname: Aspelund
authors.forename: Jason C
authors.initials: JC
authors.lastname: Fisher
authors.forename: Lynn L
authors.initials: LL
authors.lastname: Simpson
authors.forename: Charles J H
authors.initials: CJ
authors.lastname: Stolar
mesh_terms: D005260:Female; D006257:Head / Q000000981:diagnostic imaging; D006548:Hernia, Diaphragmatic / Q000000981:diagnostic imaging / Q000401:mortality; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging; D008168:Lung / Q000000981:diagnostic imaging; D008297:Male; D009519:New York City / Q000453:epidemiology; D011247:Pregnancy; D012189:Retrospective Studies; D016216:Ultrasonography, Prenatal