Prediction and probability of neonatal outcome in isolated congenital diaphragmatic hernia using multiple ultrasound parameters
Objectives To evaluate the accuracy and probabilities of different fetal ultrasound parameters to predict neonatal outcome in isolated congenital diaphragmatic hernia (CDH). Methods Between January 2004 and December 2010, we evaluated prospectively 108 fetuses with isolated CDH (82 left‐sided and 26...
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| Veröffentlicht in: | Ultrasound in obstetrics & gynecology 2012-01, Vol.39 (1), p.42-49 |
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| creator | Ruano, R. Takashi, E. da Silva, M. M. Campos, J. A. D. B. Tannuri, U. Zugaib, M. |
| description | Objectives
To evaluate the accuracy and probabilities of different fetal ultrasound parameters to predict neonatal outcome in isolated congenital diaphragmatic hernia (CDH).
Methods
Between January 2004 and December 2010, we evaluated prospectively 108 fetuses with isolated CDH (82 left‐sided and 26 right‐sided). The following parameters were evaluated: gestational age at diagnosis, side of the diaphragmatic defect, presence of polyhydramnios, presence of liver herniated into the fetal thorax (liver‐up), lung‐to‐head ratio (LHR) and observed/expected LHR (o/e‐LHR), observed/expected contralateral and total fetal lung volume (o/e‐ContFLV and o/e‐TotFLV) ratios, ultrasonographic fetal lung volume/fetal weight ratio (US‐FLW), observed/expected contralateral and main pulmonary artery diameter (o/e‐ContPA and o/e‐MPA) ratios and the contralateral vascularization index (Cont‐VI). The outcomes were neonatal death and severe postnatal pulmonary arterial hypertension (PAH).
Results
Neonatal mortality was 64.8% (70/108). Severe PAH was diagnosed in 68 (63.0%) cases, of which 63 died neonatally (92.6%) (P < 0.001). Gestational age at diagnosis, side of the defect and polyhydramnios were not associated with poor outcome (P > 0.05). LHR, o/e‐LHR, liver‐up, o/e‐ContFLV, o/e‐TotFLV, US‐FLW, o/e‐ContPA, o/e‐MPA and Cont‐VI were associated with both neonatal death and severe postnatal PAH (P < 0.001). Receiver–operating characteristics curves indicated that measuring total lung volumes (o/e‐TotFLV and US‐FLW) was more accurate than was considering only the contralateral lung sizes (LHR, o/e‐LHR and o/e‐ContFLV; P < 0.05), and Cont‐VI was the most accurate ultrasound parameter to predict neonatal death and severe PAH (P < 0.001).
Conclusions
Evaluating total lung volumes is more accurate than is measuring only the contralateral lung size. Evaluating pulmonary vascularization (Cont‐VI) is the most accurate predictor of neonatal outcome. Estimating the probability of survival and severe PAH allows classification of cases according to prognosis. Copyright © 2011 ISUOG. Published by John Wiley & Sons, Ltd. |
| doi_str_mv | 10.1002/uog.10095 |
| format | Article |
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To evaluate the accuracy and probabilities of different fetal ultrasound parameters to predict neonatal outcome in isolated congenital diaphragmatic hernia (CDH).
Methods
Between January 2004 and December 2010, we evaluated prospectively 108 fetuses with isolated CDH (82 left‐sided and 26 right‐sided). The following parameters were evaluated: gestational age at diagnosis, side of the diaphragmatic defect, presence of polyhydramnios, presence of liver herniated into the fetal thorax (liver‐up), lung‐to‐head ratio (LHR) and observed/expected LHR (o/e‐LHR), observed/expected contralateral and total fetal lung volume (o/e‐ContFLV and o/e‐TotFLV) ratios, ultrasonographic fetal lung volume/fetal weight ratio (US‐FLW), observed/expected contralateral and main pulmonary artery diameter (o/e‐ContPA and o/e‐MPA) ratios and the contralateral vascularization index (Cont‐VI). The outcomes were neonatal death and severe postnatal pulmonary arterial hypertension (PAH).
Results
Neonatal mortality was 64.8% (70/108). Severe PAH was diagnosed in 68 (63.0%) cases, of which 63 died neonatally (92.6%) (P < 0.001). Gestational age at diagnosis, side of the defect and polyhydramnios were not associated with poor outcome (P > 0.05). LHR, o/e‐LHR, liver‐up, o/e‐ContFLV, o/e‐TotFLV, US‐FLW, o/e‐ContPA, o/e‐MPA and Cont‐VI were associated with both neonatal death and severe postnatal PAH (P < 0.001). Receiver–operating characteristics curves indicated that measuring total lung volumes (o/e‐TotFLV and US‐FLW) was more accurate than was considering only the contralateral lung sizes (LHR, o/e‐LHR and o/e‐ContFLV; P < 0.05), and Cont‐VI was the most accurate ultrasound parameter to predict neonatal death and severe PAH (P < 0.001).
Conclusions
Evaluating total lung volumes is more accurate than is measuring only the contralateral lung size. Evaluating pulmonary vascularization (Cont‐VI) is the most accurate predictor of neonatal outcome. Estimating the probability of survival and severe PAH allows classification of cases according to prognosis. Copyright © 2011 ISUOG. Published by John Wiley & Sons, Ltd.</description><identifier>ISSN: 0960-7692</identifier><identifier>EISSN: 1469-0705</identifier><identifier>DOI: 10.1002/uog.10095</identifier><identifier>PMID: 21898639</identifier><identifier>CODEN: UOGYFJ</identifier><language>eng</language><publisher>Chichester, UK: John Wiley & Sons, Ltd</publisher><subject>3D ultrasonography ; Algorithms ; Balloon Occlusion - methods ; Biological and medical sciences ; Cardiovascular system ; congenital diaphragmatic hernia ; Female ; Fetal Diseases - diagnostic imaging ; Fetal Diseases - mortality ; Fetal Diseases - therapy ; Gestational Age ; Gynecology. Andrology. Obstetrics ; Hernia, Diaphragmatic - diagnostic imaging ; Hernia, Diaphragmatic - embryology ; Hernia, Diaphragmatic - mortality ; Hernia, Diaphragmatic - therapy ; Hernias, Diaphragmatic, Congenital ; Humans ; Hypertension, Pulmonary - diagnostic imaging ; Infant, Newborn ; Investigative techniques, diagnostic techniques (general aspects) ; Lung - diagnostic imaging ; Lung - physiopathology ; Lung Volume Measurements ; Male ; Medical sciences ; power Doppler ; Predictive Value of Tests ; Pregnancy ; Pregnancy Outcome ; Probability ; Prospective Studies ; pulmonary hypoplasia ; Reproducibility of Results ; ROC Curve ; Survival Analysis ; three‐dimensional ultrasonography ; Ultrasonic investigative techniques ; Ultrasonography, Doppler - methods ; Ultrasonography, Prenatal - methods</subject><ispartof>Ultrasound in obstetrics & gynecology, 2012-01, Vol.39 (1), p.42-49</ispartof><rights>Copyright © 2011 ISUOG. Published by John Wiley & Sons, Ltd.</rights><rights>2015 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4515-c7c1ac0cf137b9460524ac2be580086adf7fe836077abd0939063d1c6af216543</citedby><cites>FETCH-LOGICAL-c4515-c7c1ac0cf137b9460524ac2be580086adf7fe836077abd0939063d1c6af216543</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fuog.10095$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fuog.10095$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1416,1432,27922,27923,45572,45573,46407,46831</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=25412673$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21898639$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ruano, R.</creatorcontrib><creatorcontrib>Takashi, E.</creatorcontrib><creatorcontrib>da Silva, M. M.</creatorcontrib><creatorcontrib>Campos, J. A. D. B.</creatorcontrib><creatorcontrib>Tannuri, U.</creatorcontrib><creatorcontrib>Zugaib, M.</creatorcontrib><title>Prediction and probability of neonatal outcome in isolated congenital diaphragmatic hernia using multiple ultrasound parameters</title><title>Ultrasound in obstetrics & gynecology</title><addtitle>Ultrasound Obstet Gynecol</addtitle><description>Objectives
To evaluate the accuracy and probabilities of different fetal ultrasound parameters to predict neonatal outcome in isolated congenital diaphragmatic hernia (CDH).
Methods
Between January 2004 and December 2010, we evaluated prospectively 108 fetuses with isolated CDH (82 left‐sided and 26 right‐sided). The following parameters were evaluated: gestational age at diagnosis, side of the diaphragmatic defect, presence of polyhydramnios, presence of liver herniated into the fetal thorax (liver‐up), lung‐to‐head ratio (LHR) and observed/expected LHR (o/e‐LHR), observed/expected contralateral and total fetal lung volume (o/e‐ContFLV and o/e‐TotFLV) ratios, ultrasonographic fetal lung volume/fetal weight ratio (US‐FLW), observed/expected contralateral and main pulmonary artery diameter (o/e‐ContPA and o/e‐MPA) ratios and the contralateral vascularization index (Cont‐VI). The outcomes were neonatal death and severe postnatal pulmonary arterial hypertension (PAH).
Results
Neonatal mortality was 64.8% (70/108). Severe PAH was diagnosed in 68 (63.0%) cases, of which 63 died neonatally (92.6%) (P < 0.001). Gestational age at diagnosis, side of the defect and polyhydramnios were not associated with poor outcome (P > 0.05). LHR, o/e‐LHR, liver‐up, o/e‐ContFLV, o/e‐TotFLV, US‐FLW, o/e‐ContPA, o/e‐MPA and Cont‐VI were associated with both neonatal death and severe postnatal PAH (P < 0.001). Receiver–operating characteristics curves indicated that measuring total lung volumes (o/e‐TotFLV and US‐FLW) was more accurate than was considering only the contralateral lung sizes (LHR, o/e‐LHR and o/e‐ContFLV; P < 0.05), and Cont‐VI was the most accurate ultrasound parameter to predict neonatal death and severe PAH (P < 0.001).
Conclusions
Evaluating total lung volumes is more accurate than is measuring only the contralateral lung size. Evaluating pulmonary vascularization (Cont‐VI) is the most accurate predictor of neonatal outcome. Estimating the probability of survival and severe PAH allows classification of cases according to prognosis. Copyright © 2011 ISUOG. Published by John Wiley & Sons, Ltd.</description><subject>3D ultrasonography</subject><subject>Algorithms</subject><subject>Balloon Occlusion - methods</subject><subject>Biological and medical sciences</subject><subject>Cardiovascular system</subject><subject>congenital diaphragmatic hernia</subject><subject>Female</subject><subject>Fetal Diseases - diagnostic imaging</subject><subject>Fetal Diseases - mortality</subject><subject>Fetal Diseases - therapy</subject><subject>Gestational Age</subject><subject>Gynecology. Andrology. Obstetrics</subject><subject>Hernia, Diaphragmatic - diagnostic imaging</subject><subject>Hernia, Diaphragmatic - embryology</subject><subject>Hernia, Diaphragmatic - mortality</subject><subject>Hernia, Diaphragmatic - therapy</subject><subject>Hernias, Diaphragmatic, Congenital</subject><subject>Humans</subject><subject>Hypertension, Pulmonary - diagnostic imaging</subject><subject>Infant, Newborn</subject><subject>Investigative techniques, diagnostic techniques (general aspects)</subject><subject>Lung - diagnostic imaging</subject><subject>Lung - physiopathology</subject><subject>Lung Volume Measurements</subject><subject>Male</subject><subject>Medical sciences</subject><subject>power Doppler</subject><subject>Predictive Value of Tests</subject><subject>Pregnancy</subject><subject>Pregnancy Outcome</subject><subject>Probability</subject><subject>Prospective Studies</subject><subject>pulmonary hypoplasia</subject><subject>Reproducibility of Results</subject><subject>ROC Curve</subject><subject>Survival Analysis</subject><subject>three‐dimensional ultrasonography</subject><subject>Ultrasonic investigative techniques</subject><subject>Ultrasonography, Doppler - methods</subject><subject>Ultrasonography, Prenatal - methods</subject><issn>0960-7692</issn><issn>1469-0705</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kE1L7DAUhoNc0fFj4R-QwMWFi-pJ2yTNUobrBwi60HU5TdMx0iZjknKZlX_djjPqytU5cB7el_MQcsLgggHkl6NfrBfFd8iMlUJlIIH_ITNQAjIpVL5PDmJ8BQBRFmKP7OesUpUo1Iy8PwbTWp2sdxRdS5fBN9jY3qYV9R11xjtM2FM_Ju0HQ62jNvoek2mp9m5hnF2fW4vLl4CLAZPV9MUEZ5GO0boFHcY-2WVv6DQDRj-uWzDgYJIJ8YjsdthHc7ydh-T5-t_T_Da7f7i5m1_dZ7rkjGdaaoYadMcK2ahSAM9L1HljeAVQCWw72ZmqECAlNi2oQoEoWqYFdjkTvCwOyd9N7vTg22hiql_9GNxUWTPOZDnlfFLnG0oHH2MwXb0MdsCwqhnUa9X1pLr-VD2xp9vEsRlM-01-uZ2Asy2AUWPfBXTaxh-OlywXspi4yw333_Zm9Xtj_fxws6n-AIncl6s</recordid><startdate>201201</startdate><enddate>201201</enddate><creator>Ruano, R.</creator><creator>Takashi, E.</creator><creator>da Silva, M. M.</creator><creator>Campos, J. A. D. B.</creator><creator>Tannuri, U.</creator><creator>Zugaib, M.</creator><general>John Wiley & Sons, Ltd</general><general>Wiley</general><general>Wiley Subscription Services, Inc</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QO</scope><scope>8FD</scope><scope>FR3</scope><scope>K9.</scope><scope>P64</scope></search><sort><creationdate>201201</creationdate><title>Prediction and probability of neonatal outcome in isolated congenital diaphragmatic hernia using multiple ultrasound parameters</title><author>Ruano, R. ; Takashi, E. ; da Silva, M. M. ; Campos, J. A. D. B. ; Tannuri, U. ; Zugaib, M.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4515-c7c1ac0cf137b9460524ac2be580086adf7fe836077abd0939063d1c6af216543</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>3D ultrasonography</topic><topic>Algorithms</topic><topic>Balloon Occlusion - methods</topic><topic>Biological and medical sciences</topic><topic>Cardiovascular system</topic><topic>congenital diaphragmatic hernia</topic><topic>Female</topic><topic>Fetal Diseases - diagnostic imaging</topic><topic>Fetal Diseases - mortality</topic><topic>Fetal Diseases - therapy</topic><topic>Gestational Age</topic><topic>Gynecology. Andrology. Obstetrics</topic><topic>Hernia, Diaphragmatic - diagnostic imaging</topic><topic>Hernia, Diaphragmatic - embryology</topic><topic>Hernia, Diaphragmatic - mortality</topic><topic>Hernia, Diaphragmatic - therapy</topic><topic>Hernias, Diaphragmatic, Congenital</topic><topic>Humans</topic><topic>Hypertension, Pulmonary - diagnostic imaging</topic><topic>Infant, Newborn</topic><topic>Investigative techniques, diagnostic techniques (general aspects)</topic><topic>Lung - diagnostic imaging</topic><topic>Lung - physiopathology</topic><topic>Lung Volume Measurements</topic><topic>Male</topic><topic>Medical sciences</topic><topic>power Doppler</topic><topic>Predictive Value of Tests</topic><topic>Pregnancy</topic><topic>Pregnancy Outcome</topic><topic>Probability</topic><topic>Prospective Studies</topic><topic>pulmonary hypoplasia</topic><topic>Reproducibility of Results</topic><topic>ROC Curve</topic><topic>Survival Analysis</topic><topic>three‐dimensional ultrasonography</topic><topic>Ultrasonic investigative techniques</topic><topic>Ultrasonography, Doppler - methods</topic><topic>Ultrasonography, Prenatal - methods</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ruano, R.</creatorcontrib><creatorcontrib>Takashi, E.</creatorcontrib><creatorcontrib>da Silva, M. M.</creatorcontrib><creatorcontrib>Campos, J. A. D. B.</creatorcontrib><creatorcontrib>Tannuri, U.</creatorcontrib><creatorcontrib>Zugaib, M.</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Biotechnology Research Abstracts</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><jtitle>Ultrasound in obstetrics & gynecology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ruano, R.</au><au>Takashi, E.</au><au>da Silva, M. M.</au><au>Campos, J. A. D. B.</au><au>Tannuri, U.</au><au>Zugaib, M.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Prediction and probability of neonatal outcome in isolated congenital diaphragmatic hernia using multiple ultrasound parameters</atitle><jtitle>Ultrasound in obstetrics & gynecology</jtitle><addtitle>Ultrasound Obstet Gynecol</addtitle><date>2012-01</date><risdate>2012</risdate><volume>39</volume><issue>1</issue><spage>42</spage><epage>49</epage><pages>42-49</pages><issn>0960-7692</issn><eissn>1469-0705</eissn><coden>UOGYFJ</coden><abstract>Objectives
To evaluate the accuracy and probabilities of different fetal ultrasound parameters to predict neonatal outcome in isolated congenital diaphragmatic hernia (CDH).
Methods
Between January 2004 and December 2010, we evaluated prospectively 108 fetuses with isolated CDH (82 left‐sided and 26 right‐sided). The following parameters were evaluated: gestational age at diagnosis, side of the diaphragmatic defect, presence of polyhydramnios, presence of liver herniated into the fetal thorax (liver‐up), lung‐to‐head ratio (LHR) and observed/expected LHR (o/e‐LHR), observed/expected contralateral and total fetal lung volume (o/e‐ContFLV and o/e‐TotFLV) ratios, ultrasonographic fetal lung volume/fetal weight ratio (US‐FLW), observed/expected contralateral and main pulmonary artery diameter (o/e‐ContPA and o/e‐MPA) ratios and the contralateral vascularization index (Cont‐VI). The outcomes were neonatal death and severe postnatal pulmonary arterial hypertension (PAH).
Results
Neonatal mortality was 64.8% (70/108). Severe PAH was diagnosed in 68 (63.0%) cases, of which 63 died neonatally (92.6%) (P < 0.001). Gestational age at diagnosis, side of the defect and polyhydramnios were not associated with poor outcome (P > 0.05). LHR, o/e‐LHR, liver‐up, o/e‐ContFLV, o/e‐TotFLV, US‐FLW, o/e‐ContPA, o/e‐MPA and Cont‐VI were associated with both neonatal death and severe postnatal PAH (P < 0.001). Receiver–operating characteristics curves indicated that measuring total lung volumes (o/e‐TotFLV and US‐FLW) was more accurate than was considering only the contralateral lung sizes (LHR, o/e‐LHR and o/e‐ContFLV; P < 0.05), and Cont‐VI was the most accurate ultrasound parameter to predict neonatal death and severe PAH (P < 0.001).
Conclusions
Evaluating total lung volumes is more accurate than is measuring only the contralateral lung size. Evaluating pulmonary vascularization (Cont‐VI) is the most accurate predictor of neonatal outcome. Estimating the probability of survival and severe PAH allows classification of cases according to prognosis. Copyright © 2011 ISUOG. Published by John Wiley & Sons, Ltd.</abstract><cop>Chichester, UK</cop><pub>John Wiley & Sons, Ltd</pub><pmid>21898639</pmid><doi>10.1002/uog.10095</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Ultrasound in obstetrics & gynecology, 2012-01, Vol.39 (1), p.42-49 |
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| source | MEDLINE; Wiley Online Library Journals Frontfile Complete; Wiley Free Content; EZB-FREE-00999 freely available EZB journals |
| subjects | 3D ultrasonography Algorithms Balloon Occlusion - methods Biological and medical sciences Cardiovascular system congenital diaphragmatic hernia Female Fetal Diseases - diagnostic imaging Fetal Diseases - mortality Fetal Diseases - therapy Gestational Age Gynecology. Andrology. Obstetrics Hernia, Diaphragmatic - diagnostic imaging Hernia, Diaphragmatic - embryology Hernia, Diaphragmatic - mortality Hernia, Diaphragmatic - therapy Hernias, Diaphragmatic, Congenital Humans Hypertension, Pulmonary - diagnostic imaging Infant, Newborn Investigative techniques, diagnostic techniques (general aspects) Lung - diagnostic imaging Lung - physiopathology Lung Volume Measurements Male Medical sciences power Doppler Predictive Value of Tests Pregnancy Pregnancy Outcome Probability Prospective Studies pulmonary hypoplasia Reproducibility of Results ROC Curve Survival Analysis three‐dimensional ultrasonography Ultrasonic investigative techniques Ultrasonography, Doppler - methods Ultrasonography, Prenatal - methods |
| title | Prediction and probability of neonatal outcome in isolated congenital diaphragmatic hernia using multiple ultrasound parameters |
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