Abstract
Objective: Valid postnatal prediction parameters for neonates with congenital diaphragmatic hernia (CDH) are lacking, but recently, the chest radiographic thoracic area (CRTA) was proposed to predict survival with high sensitivity. Here, we evaluated whether the CRTA correlated with morbidity and mortality in neonates with CDH and was able to predict these with higher sensitivity and specificity than prenatal observed-to-expected (O/E) lung-to-head ratio (LHR).Methods: In this retrospective cohort study, all neonates with CDH admitted to our institution between 2013 and 2019 were included. The CRTA was measured using the software Horos (V. 3.3.5) and compared with O/E LHR diagnosed by fetal ultrasonography in relation to outcome parameters including survival, extracorporeal membrane oxygenation (ECMO) support, and chronic lung disease (CLD).Results: In this study 255 neonates were included with a survival to discharge of 84%, ECMO support in 46%, and 56% developing a CLD. Multiple regression analysis demonstrated that the CRTA correlates significantly with survival (p = 0.001), ECMO support (p < 0.0001), and development of CLD (p = 0.0193). The CRTA displayed a higher prognostic validity for survival [area under the curve (AUC) = 0.822], ECMO support (AUC = 0.802), and developing a CLD (AUC = 0.855) compared with the O/E LHR.Conclusions: Our data suggest that the postnatal CRTA might be a better prognostic parameter for morbidity and mortality than the prenatal O/E LHR.
Highlights
Congenital diaphragmatic hernia (CDH) is characterized by failure of diaphragmatic development and thoracic herniation of abdominal organs, leading to lung hypoplasia and persistent pulmonary hypertension of the newborn (PPHN) [1]
The chest radiographic thoracic area (CRTA) was measured using the software Horos (V. 3.3.5) and compared with O/E lung-to-head ratio (LHR) diagnosed by fetal ultrasonography in relation to outcome parameters including survival, extracorporeal membrane oxygenation (ECMO) support, and chronic lung disease (CLD)
In this study 255 neonates were included with a survival to discharge of 84%, ECMO support in 46%, and 56% developing a CLD
Summary
Congenital diaphragmatic hernia (CDH) is characterized by failure of diaphragmatic development and thoracic herniation of abdominal organs, leading to lung hypoplasia and persistent pulmonary hypertension of the newborn (PPHN) [1]. Besides PPHN, is an important determinant marker for mortality and morbidity in CDH patients [2], quantification of the absolute lung volume is a tool to predict prognosis [3,4,5]. Measuring O/E LHR has been established as standard approach, this parameter can be utilized only in patients with prenatal diagnosis of CDH. For this reason, it would be preferable to establish a parameter for prognosis, which is dependent only on postnatal data. Estimation of the chest radiographic thoracic area (CRTA) is an alternative to assess lung volume on a chest radiograph [10, 11]. It has been demonstrated that CRTA can predict survival in infants with severe CDH with high sensitivity and moderate specificity [12]
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