Quantitative Lung Index, Contralateral Lung Area, or Lung-to-Head Ratio to Predict the Neonatal Outcome in Isolated Congenital Diaphragmatic Hernia?

Abstract

The observed-to-expected total lung volume is the most accurate predictor of the neonatal outcome in cases of isolated congenital diaphragmatic hernia. Both the quantitative lung index and observed-to-expected contralateral lung area, albeit reasonably accurate, do not produce the same level of accuracy and render similar results as the lung-to-head ratio and observed-to-expected lung-to-head ratio.

Prediction of Postnatal Outcomes in Fetuses With Isolated Congenital Diaphragmatic Hernias Using Different Lung‐to‐Head Ratio Measurements

“…Assessment of fetal lung volume by magnetic resonance imaging and 3‐dimensional sonography as well as pulmonary Doppler examination might be helpful 28 – 30 . It was also shown in previous investigations that the lung‐to‐head ratio and observed‐to‐expected lung‐to‐head ratio had similar accuracy, and measuring total lung volumes was more precise than considering only contralateral lung sizes 26 , 31 …”

“…[28][29][30] It was also shown in previous investigations that the lung-to-head ratio and observed-to-expected lung-to-head ratio had similar accuracy, and measuring total lung volumes was more precise than considering only contralateral lung sizes. 26,31 This trial was undertaken in an ECMO center. This circumstance might have influenced the survival rate, since postpartum survival is also related to the expertise of the neonatal center caring for the affected neonate.…”

Prenatal prediction of neonatal survival in cases diagnosed with congenital diaphragmatic hernia using abdomen‐to‐thorax ratio determined by ultrasonography

“…In addition, there is another problem that normal LHR is increased with advancing gestation. Although additional standardization in the form of the o/e LHR and QLI have been developed to compensate the weakness, the actual utility of them may still be limited . Actually, there was no significant association between the o/e LHR and survival in our cases.…”

“…The expected LHR using longest diameter method is calculated as expected right LHR in left CDH = −3.4802 + (0.3995 × GA) – (0.0048 × GA ∧ 2) and as expected left LHR in right CDH = −2.5957 + (0.3043 × GA) – (0.0042 × GA ∧ 2) Quantitative lung index (QLI), which is calculated as quantitative lung index = contralateral lung area/(head circumference/10) ∧ 2 Side of the diaphragmatic defect (left or right). Presence of intrathoracic liver (‘liver up’). Presence of intrathoracic stomach. Presence of intrathoracic bowel. Presence of intrathoracic other solid organs. Presence of polyhydramnios (amniotic fluid index >25 cm or maximal vertical pocket >8 cm). Mediastinal shift, which is a deviation of the mediastinum and its contents away from its normal midline location. …”

Lung size and liver herniation predict need for extracorporeal membrane oxygenation but not pulmonary hypertension in isolated congenital diaphragmatic hernia: systematic review and meta‐analysis

“…postnatal series, n = 5), in addition to a number of other reasons ( n = 15). Of the selected papers, 15 reported on the occurrence of PPH, 19 on the need for ECMO and four reported on both outcomes (Figure ). The corresponding authors of seven studies provided relevant unpublished data.…”