APSA PaperPercent predicted lung volumes as measured on fetal magnetic resonance imaging: a useful biometric parameter for risk stratification in congenital diaphragmatic hernia
Section snippets
Materials and methods
This prospective study was conducted under an approved institutional review board protocol (M02-10-240). From December 2000 to January 2005, 74 fetuses with sonographically diagnosed CDH were referred to the Advanced Fetal Care Center at Children's Hospital Boston. Confirmatory prenatal sonograms (ATL 5000, Philips, Bothell, Wash, or Sequoia, Siemens, Mountain View, Calif) were performed. When gestational age was appropriate and fetal lie permitted, LHR was calculated during these examinations.
Results
There were 12 left-sided and 5 right-sided hernias. Seventy-one percent had prenatal evidence of liver herniation. Three pregnancies were electively terminated, resulting in 14 patients with postnatal outcomes data. The gestational age at MR imaging and gestational age at birth were 22.3 ± 5.7 weeks and 37.3 ± 1.1 weeks, respectively. The birth weight was 2949 ± 414 g. Six patients underwent controlled intubation as part of an EXIT procedure. Forty-seven percent required substantial ECMO
Discussion
Over the past 2 decades, there have been numerous attempts to use prenatal ultrasound as an imaging tool to accurately predict the degree of pulmonary hypoplasia in CDH [1], [18], [19], [20], [21], [22], [23]. Ultrasound markers that have been associated with a higher mortality include a diagnosis before 25 weeks gestation, an intrathoracic stomach, right-sided defect, polyhydraminos, and liver herniation [3], [18]. Additionally, various sonographic biometric parameters, including the LHR, have
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