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Third-trimester percentage predicted lung volume and percentage liver herniation as prognostic indicators in congenital diaphragmatic hernia

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Abstract

Background

Over the last two decades, fetal imaging has greatly improved, and new prenatal imaging measurements have been developed to characterize congenital diaphragmatic hernia (CDH) severity.

Objective

To determine the best prenatal imaging predictor of postnatal CDH outcomes, including use of extracorporeal membrane oxygenation (ECMO) and in-hospital mortality, with particular attention to the percentage of liver herniation (%LH) as a predictor. Additionally, we sought to guide best practices across hospital systems including improved models of prenatal risk assessment.

Materials and methods

We conducted a retrospective review of infants with left CDH who were prenatally diagnosed. We analyzed prenatal imaging measurements including observed-to-expected (O/E) lung-to-head ratio (LHR) on US, percentage predicted lung volume (PPLV) on MRI, and O/E total fetal lung volume (TFLV) and %LH on MRI. We compared prenatal imaging characteristics for infants with (1) in-hospital postnatal mortality and (2) use of ECMO. Then we performed multivariate logistic regression to determine independent predictors of postnatal outcomes.

Results

We included 63 infants with a median gestation of 34 weeks at the time of prenatal MRI. Low O/E LHR (31.2 vs. 50, P < 0.0001), PPLV (14.7 vs. 22.6, P < 0.0001) and O/E TLFV (24.6 vs. 38.3, P < 0.0001) and high %LH (15.1 vs. 2.1, P = 0.0006) were associated with worse postnatal outcomes; however, only PPLV was predictive of survival and need for ECMO on multivariable analysis. PPLV survival to discharge model showed an area under the curve (AUC) of 0.93 (95% confidence interval [CI]: 0.86, 0.99), P < 0.0001; and an odds ratio of 68.7 (95% CI: 6.5–2,302), P = 0.003. PPLV need for ECMO model showed AUC = 0.87 (95% CI: 0.78, 0.96), P < 0.0001; and odds ratio = 20.1 (95% CI: 3.1–226.3), P = 0.011.

Conclusion

Low O/E LHR, PPLV and O/E TFLV and high %LH in the third trimester are associated with worse postnatal outcomes. PPLV most strongly predicted outcome using a logistic regression model. Percentage of liver herniation was not an independent predictor of outcomes.

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Authors and Affiliations

  1. Department of Surgery, Laboratory for Fetal and Regenerative Biology, University of Colorado Denver School of Medicine and Children’s Hospital Colorado, Aurora, CO, USA

    Stephen M. Niemiec, Amanda E. Louiselle, Ryan Phillips & Kenneth W. Liechty

  2. Department of Radiology, Children’s Hospital Colorado, 13123 E. 16th Ave., Aurora, CO, 80045, USA

    Stephen M. Niemiec, Amanda E. Louiselle, Ryan Phillips, Jason Gien, Michael V. Zaretsky, Sarkis C. Derderian, Kenneth W. Liechty & Mariana L. Meyers

  3. Department of Surgery, Division of Pediatric Surgery, University of Colorado School of Medicine, Aurora, CO, USA

    Stephen M. Niemiec, Amanda E. Louiselle, Ryan Phillips, Sarkis C. Derderian & Kenneth W. Liechty

  4. Department of Pediatrics Section of Neonatology, Children’s Hospital of Colorado, Aurora, CO, USA

    Jason Gien

  5. Colorado Fetal Care Center, Children’s Hospital of Colorado, Colorado Institute for Fetal & Maternal Health, Aurora, CO, USA

    Jason Gien, Michael V. Zaretsky, Sarkis C. Derderian, Kenneth W. Liechty & Mariana L. Meyers

  6. Department of Radiology, Division of Pediatric Radiology, University of Colorado School of Medicine, Aurora, CO, USA

    Mariana L. Meyers

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  1. Stephen M. Niemiec
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  2. Amanda E. Louiselle
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  3. Ryan Phillips
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  4. Jason Gien
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  8. Mariana L. Meyers
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Correspondence to Mariana L. Meyers.

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Niemiec, S.M., Louiselle, A.E., Phillips, R. et al. Third-trimester percentage predicted lung volume and percentage liver herniation as prognostic indicators in congenital diaphragmatic hernia. Pediatr Radiol 53, 479–486 (2023). https://doi.org/10.1007/s00247-022-05538-w

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  • DOI: https://doi.org/10.1007/s00247-022-05538-w

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