Rate of increase of lung-to-head ratio over the course of gestation is predictive of survival in left-sided congenital diaphragmatic hernia.
OBJECTIVE
Congenital diaphragmatic hernia (CDH) is associated with high postnatal mortality because of pulmonary hypoplasia. The prognostic utility of serial lung-to-head circumference measurements as a marker of lung growth has not been described. Our objective was to examine the relationship between the rate of interval increase of LHR and postnatal survival in left-sided CDH.


METHODS
We retrospectively reviewed charts of all left-sided CDH patients from January 2004 to July 2014. All ultrasound studies performed at our institution (n=473) were reviewed. Categorical and continuous data were analyzed by chi-square and Mann-Whitney t-test, respectively, and slope analysis was performed by linear regression analysis (p<0.05).


RESULTS
A total of 226 patients were studied, with 154 long-term survivors and 72 non-survivors. Established markers of CDH severity, including intrathoracic liver position and requirement for patch repair, were significantly increased in non-survivors (p<0.0001). The rate of LHR increase as measured by linear regression and slope analysis was significantly increased in long-term survivors (p=0.0175).


CONCLUSIONS
Our findings indicate that the interval increase in LHR levels over the course of gestation correlate with survival in left-sided CDH patients. Regular ultrasonographic re-evaluation of LHR throughout gestation following diagnosis of CDH may provide prognostic insight and help guide patient management.
The Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, PA, 19104.
Emily A
EA
Partridge
The Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, PA, 19104.
William H
WH
Peranteau
The Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, PA, 19104.
Lisa
L
Herkert
The Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, PA, 19104.
Natalie E
NE
Rintoul
The Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, PA, 19104.
Alan W
AW
Flake
The Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, PA, 19104.
N Scott
NS
Adzick
The Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, PA, 19104. Electronic address: Hedrick@email.chop.edu.
Holly L
HL
Hedrick
D016009:Chi-Square Distribution; D005260:Female; D005865:Gestational Age; D006257:Head / Q000000981:diagnostic imaging / Q000196:embryology / Q000473:pathology*; D065630:Hernias, Diaphragmatic, Congenital / Q000000981:diagnostic imaging / Q000401:mortality* / Q000473:pathology*; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging / Q000196:embryology / Q000473:pathology*; D008297:Male; D011247:Pregnancy; D011379:Prognosis; D012044:Regression Analysis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014463:Ultrasonography; D016216:Ultrasonography, Prenatal
Congenital diaphragmatic hernia; Lung-to-head circumference ratio; Prognosis