Link: http://www.ncbi.nlm.nih.gov/pubmed/27261559

J Pediatr Surg. 2016 May;51(5):703-5. doi: 10.1016/j.jpedsurg.2016.02.006. Epub 2016 Feb 11.
Rate of increase of lung-to-head ratio over the course of gestation is predictive of survival in left-sided congenital diaphragmatic hernia.
Partridge EA1, Peranteau WH1, Herkert L1, Rintoul NE1, Flake AW1, Adzick NS1, Hedrick HL2.
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Abstract
PURPOSE:
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.
Copyright © 2016. Published by Elsevier Inc.
KEYWORDS:
Congenital diaphragmatic hernia; Lung-to-head circumference ratio; Prognosis
PMID: 27261559 [PubMed - in process]