Lung volume assessment with 3D ultrasound and liver position to predict postnatal outcome in fetuses with isolated congenital diaphragmatic hernia

Abstract

PREDICT POSTNATAL OUTCOME IN FETUSES WITH ISOLATED CONGENITAL DIAPHRAGMATIC HERNIA JACQUES JANI, FABIO PERALTA, ALEXANDRA BENACHI, RODRIGO RUANO, KYPROS NICOLAIDES, JAN DEPREST, University Hospital Leuven, Obstetrics and Gynecology, Leuven, Belgium, King’s College Hospital, Harris Birthright Research Centre, London, United Kingdom, Hopital Necker-Enfants Malades, Obstetrics and Gynecology, Paris, France OBJECTIVE: To predict neonatal survival of fetuses with isolated congenital diaphragmatic hernia (CDH) by assessment of total fetal lung volume (FLV) using 3D ultrasound and liver position. STUDY DESIGN: Prospective study in 3 tertiary units from 2003 onwards including 34 left and 4 right CDH, who were expectantly managed and live born after 34 wks gestation (GA). Outcome measures were position of the liver by ultrasound or in doubt MRI, total FLV, calculated observed/expected (O/ E) total FLV ratio based on the mean for gestation (Peralta, Ultrasound Obstet Gynecol 2006; 27:128-33) and survival at discharge from neonatal intensive care unit. RESULTS: Mean gestational age at lung assessment was 26.8 wks (range 21-36) and at delivery 38.5 wks (range 36-41). There were no postnatal diagnoses of structural or chromosomal anomalies. Overall survival rate was 71% (27/38; right: 3/4; left 24/34). For left sided cases with the liver up, survival was 12% when O/E ratio was !30% (1/8; O/E ratio=21.5%), increasing to 62% (5/8) when O/E R 30%. In the liver down group, all fetuses but one survived (21/22). On average their O/E ratio was 40.1% (range: 17.7-90%); the fetus that died had an O/E ratio=29.6%. CONCLUSION: In fetuses with isolated CDH and liver up, survival can be predicted by low (O/E!30%) lung volume. Fetuses with liver down are likely to survive, irrespective of their lung volume as assessed by the O/E ratio. This confirms earlier findings in a study looking at 2Dassessment of the lungs (Jani Ultrasound Obstet Gynecol 2006; 27:18-22).