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J Pediatr Surg. 2007 Jan;42(1):107-10; discussion 110-1.

Fetal lung-head ratio is not related to outcome for antenatal diagnosed congenital diaphragmatic hernia.

Author information

1
Division of Pediatric Surgery, College of Physicians and Surgeons, Columbia University and The Center for Prenatal Pediatrics, Morgan Stanley Children's Hospital of New York-Presbyterian, New York City, NY 10032-3784, USA. ma2161@columbia.edu

Abstract

We asked if fetal lung-to-head ratio (LHR) of 1.0 or lower or liver herniation had a statistical effect on survival or need for extracorporeal membrane oxygenation (ECMO), compared with LHR above 1.0 in patients with congenital diaphragmatic hernia (CDH).

METHODS:

Antenatal records of all patients diagnosed with CDH from January of 2002 to June of 2005 were examined. Inclusion criteria were isolated left-sided CDH and absence of significant cardiac or other anomalies/syndromes, treated solely at this institution. Lung-to-head ratio values were compared based on the value currently proposed for fetal intervention: LHR of 1.0 or lower vs LHR above 1.0. Outcome was assessed as survival (discharge to home) or need for ECMO.

RESULTS:

Twenty-eight patients met inclusion criteria. Overall survival was 86% (24/28). Postnatal survival in fetuses with LHR of 1.0 or lower (8/11) was not statistically different from LHR above 1.0 (16/17) (73% vs 94%, P = .114). The need for ECMO in the group with LHR of 1.0 or lower (3/11) was not significantly different from those with LHR above 1.0 (1/17) (27% vs 6%, P = .114). Herniation of the fetal liver into the chest did not affect survival or need for ECMO (P = .228).

CONCLUSION:

Neither LHR of 1.0 or lower nor liver herniation identified a risk factor significant enough to warrant fetal intervention. Multicenter studies may be more appropriate to investigate this clinical problem.

PMID:
17208549
DOI:
10.1016/j.jpedsurg.2006.09.010
[Indexed for MEDLINE]

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