Standardization of Sonographic Lung-to-Head Ratio Measurements in Isolated Congenital Diaphragmatic Hernia Impact on the Reproducibility and Efficacy to Predict Outcomes

Author(s):Show less -

Britto, Ingrid Schwach Werneck ^{[1, 2]} ; Sananes, Nicolas ^{[1, 2]} ; Olutoye, Oluyinka O. ^{[2, 3]} ; Cass, Darrell L. ^{[2, 3]} ; Sangi-Haghpeykar, Haleh ^[1] ; Lee, Timothy C. ^{[2, 3]} ; Cassady, Christopher I. ^{[2, 4]} ; Mehollin-Ray, Amy ^{[2, 4]} ; Welty, Stephen ^{[2, 5]} ; Fernandes, Caraciolo ^{[2, 5]} ; Belfort, Michael A. ^{[1, 2]} ; Lee, Wesley ^{[1, 2]} ; Ruano, Rodrigo ^{[1, 2]}

Affiliation

^[1] Baylor Coll Med, Dept Obstet & Gynecol, Houston, TX 77030 - USA

^[2] Texas Childrens Fetal Ctr, Houston, TX 77030 - USA

^[3] Baylor Coll Med, Michael E DeBakey Dept Surg, Houston, TX 77030 - USA

^[4] Baylor Coll Med, Dept Radiol, Houston, TX 77030 - USA

^[5] Baylor Coll Med, Dept Pediat, Sect Neonatol, Houston, TX 77030 - USA

• Document type: Journal article
• Source: JOURNAL OF ULTRASOUND IN MEDICINE; v. 34, n. 10, p. 1721-1727, OCT 2015.
• Web of Science Citations: 7

Abstract

Objectives-The purpose of this study was to evaluate the impact of standardization of the lung-to-head ratio measurements in isolated congenital diaphragmatic hernia on prediction of neonatal outcomes and reproducibility. Methods-We conducted a retrospective cohort study of 77 cases of isolated congenital diaphragmatic hernia managed in a single center between 2004 and 2012. We compared lung-to-head ratio measurements that were performed prospectively in our institution without standardization to standardized measurements performed according to a defined protocol. Results-The standardized lung-to-head ratio measurements were statistically more accurate than the nonstandardized measurements for predicting neonatal mortality (area under the receiver operating characteristic curve, 0.85 versus 0.732; P =.003). After standardization, there were no statistical differences in accuracy between measurements regardless of whether we considered observed-to-expected values (P>.05). Standardization of the lung-to-head ratio did not improve prediction of the need for extracorporeal membrane oxygenation (P>.05). Both intraoperator and interoperator reproducibility were good for the standardized lung-to-head ratio (intraclass correlation coefficient, 0.98 {[}95% confidence interval, 0.97-0.99]; bias, 0.02 {[}limits of agreement, -0.11 to +0.15], respectively). Conclusions-Standardization of lung-to-head ratio measurements improves prediction of neonatal outcomes. Further studies are needed to confirm these results and to assess the utility of standardization of other prognostic parameters. (AU)

• FAPESP's process: 13/12493-1 - Evaluation of pulmonary vascularization in fetuses with Congenital Diaphragmatic Hernia undergoing conservative treatment or fetal intervention through fetoscopic tracheal balloon placement
• Grantee: Ingrid Schwach Werneck Britto
• Support Opportunities: Scholarships abroad - Research