title: Congenital diaphragmatic hernia: Observed/expected lung-to-head ratio as a predictor of long-term morbidity.
abstract: OBJECTIVE
  The aim of this study was to investigate the association of observed/expected (O/E) lung-to-head ratio (LHR) with long-term morbidity for isolated fetal congenital diaphragmatic hernia (CDH) patients in a single institution.
  
  
  METHODS
  We performed a retrospective study of prenatally diagnosed CDH from 18 to 38weeks of gestation (01/2002-04/2010). Two cohorts of O/E LHR were defined (22.6-45%, 45.1-78.3%) based upon previous studies. Survivors with at least 1-year follow-up of prospectively collected long-term morbidity assessments were included.
  
  
  RESULTS
  O/E LHR was available in 43 survivors (median 40%, range 22.8-78.3%). Follow-up data were available in 41 survivors (M:F=24:17, left CDH=39/41). Median follow-up was 6.5years (1-11years). Height/weight trajectories were similar between the two cohorts, with the majority below the 50th centile. There were no differences between the two cohorts by age 3years for Bayley scales (developmental domains) and/or REEL-3 (language development). In addition, V/Q scans in the two cohorts demonstrated similar degrees of mismatch (mean delta V/Q=35.4 versus 31.3).
  
  
  CONCLUSIONS
  In fetuses with isolated CDH, a reduction in O/E LHR does not predict a worse outcome in long-term follow-up. There is no association between a lower O/E LHR and a reduction in REEL-3 or Bayley score nor V/Q mismatch.
authors.affiliation: Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Sebastian K
authors.initials: SK
authors.lastname: King
authors.affiliation: Fetal Medicine Unit, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Malikah
authors.initials: M
authors.lastname: Alfaraj
authors.affiliation: Division of Critical Care Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Rose
authors.initials: R
authors.lastname: Gaiteiro
authors.affiliation: Division of Neonatology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Karel
authors.initials: K
authors.lastname: O'Brien
authors.affiliation: Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Theo
authors.initials: T
authors.lastname: Moraes
authors.affiliation: Division of Cardiology, The Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Tilman
authors.initials: T
authors.lastname: Humpl
authors.affiliation: Division of Gastroenterology, The Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Margaret
authors.initials: M
authors.lastname: Marcon
authors.affiliation: Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Monping
authors.initials: M
authors.lastname: Chiang
authors.affiliation: Division of Cardiology, The Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Janette
authors.initials: J
authors.lastname: Reyes
authors.affiliation: Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Beth
authors.initials: B
authors.lastname: Haliburton
authors.affiliation: Fetal Medicine Unit, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Greg
authors.initials: G
authors.lastname: Ryan
authors.affiliation: Division of Critical Care Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Peter
authors.initials: P
authors.lastname: Cox
authors.affiliation: Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada. Electronic address: priscilla.chiu@sickkids.ca.
authors.forename: Priscilla P L
authors.initials: PP
authors.lastname: Chiu
mesh_terms: D002648:Child; D002675:Child, Preschool; D005260:Female; D005333:Fetus; D005865:Gestational Age; D006257:Head / Q000000981:diagnostic imaging / Q000196:embryology*; D065630:Hernias, Diaphragmatic, Congenital / Q000000981:diagnostic imaging / Q000196:embryology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008168:Lung / Q000000981:diagnostic imaging / Q000196:embryology*; D009017:Morbidity; D011247:Pregnancy; D011296:Prenatal Diagnosis / Q000379:methods*; D012189:Retrospective Studies; D016216:Ultrasonography, Prenatal
keywords: Congenital diaphragmatic hernia (CDH); Lung-to-head ratio (LHR); Morbidity; Outcome; Prognosis