The lung-to-head ratio and fetoscopic temporary tracheal occlusion: prediction of survival in severe left congenital diaphragmatic hernia

被引:50
作者
Keller, RL
Glidden, DV
Paek, BW
Goldstein, RB
Feldstein, VA
Callen, PW
Filly, RA
Albanese, CT
机构
[1] Univ Calif San Francisco, Fetal Treatment Ctr, Dept Epidemiol & Biostat, San Francisco, CA 94143 USA
[2] Univ Calif San Francisco, Fetal Treatment Ctr, Dept Surg, San Francisco, CA 94143 USA
[3] Univ Calif San Francisco, Fetal Treatment Ctr, Dept Radiol, San Francisco, CA 94143 USA
[4] Univ Calif San Francisco, Dept Pediat, San Francisco, CA 94143 USA
[5] Univ Calif San Francisco, Cardiovasc Res Inst, San Francisco, CA 94143 USA
关键词
congenital diaphragmatic hernia; fetal ultrasound; lung-to-head ratio; tracheal occlusion;
D O I
10.1002/uog.44
中图分类号
O42 [声学];
学科分类号
070206 ; 082403 ;
摘要
Objectives To evaluate the reliability of sonographic lung-to-head ratio (LHR) measurement as a predictor of survival in fetuses with congenital diaphragmatic hernia (CDH) and to compare the probability of survival in those with temporary tracheal occlusion (TO) or standard care with respect to the LHR. Methods Fifty-six fetuses with left CDH with liver herniated into the thorax at complete prenatal evaluation were included in logistic regression analyses of antenatal predictors of survival to hospital discharge. Sixteen subjects underwent TO and 40 received standard care. Results LHR was a significant predictor of survival, with probability of survival increasing with increasing LHR (odds ratio (OR) 8.5, P = 0.04). When subjects with anomalies were excluded, the LHR effect was similar after adjustment for TO (OR 7.1, P = 0.11). Linear spline models suggested a plateau in survival at an LHR of 1.0 and all models suggested increased odds of survival with TO. Minimum LHR measurements had a high degree of inter- and intraobserver agreement (intraclass correlation coefficients of 0.70 and 0.80, respectively). Conclusions Calculation of the LHR in fetuses with CDH is a reliable and powerful predictor of survival to hospital discharge, although improving odds of survival may plateau at an LHR of 1.0. TO may have an independent benefit on survival to hospital discharge. Copyright (C) 2003 ISUOG. Published by John Wiley Sons, Ltd.
引用
收藏
页码:244 / 249
页数:6
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