Value of ultrasound in predicting the prognosis of congenital diaphragmatic hernia

Abstract

Objective To explore the value of ultrasonic scan for predicting mortality in children with congenital diaphragmatic hernia (CDH). Methods Sixty-eight hospitalized CDH neonates were recruited and retrospectively analyzed from January 2010 to May 2017.Ultrasonic markers including sidedness of hernia, thoracic herniation of liver, thoracic herniation of stomach, diagnostic timing, presence of associated congenital anomalies, lung-to-head ratio (LHR) and observed/expected lung-to-head ratio (O/E LHR) were analyzed.And logistic regression analysis was performed for determining the independent predictors for mortality. Results The overall mortality rate was 39.7%(27/68). Differences existed in mortality between children with an intrathoracic liver, associated congenital anomalies and prenatally diagnosed as compared with those with an ectopic liver without anomalies and diagnosed postnatally (P 0.05). The mortality of patients with LHR≤1.4 was 50% higher than that with LHR >1.4 (P 45% (P<0.05). The area under the ROC curve for predicting mortality by LHR was 0.936 (95% CI, 0.837-1.000) and O/E LHR 0.880 (95% CI, 0.745-1.000). The value of LHR and O/E LHR for predicting mortality was not significantly different (z=0.044, P=0.483). Logistic multivariate regression analysis indicated that prenatal diagnosis, thoracic herniation of liver and associated congenital anomalies were independent predictors for mortality with odd ratios of 10.534, 8.843 and 11.234 respectively (P<0.05). Conclusions Ultrasound may become a useful tool of predicting the prognosis of CDH. Key words: Diaphragmatic hernia, congenital; Ultrasonography; Prognosis