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Research: Prediction of neonatal survival according to lung-to-head ratio in fetuses with right congenital diaphragmatic hernia (CDH): A multicentre study from the Latin American CDH Study Group registry

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Prenat Diagn

. 2021 Dec 3. doi: 10.1002/pd.6070. Online ahead of print. https://pubmed.ncbi.nlm.nih.gov/34861055/

Prediction of neonatal survival according to lung-to-head ratio in fetuses with right congenital diaphragmatic hernia (CDH): A multicentre study from the Latin American CDH Study Group registry

Rogelio Cruz-Martínez 1, Saulo Molina-Giraldo 2, Adolfo Etchegaray 3, Walter Ventura 4, Néstor Pavón-Gómez 5, Enrique Gil-Guevara 6, Rosa Villalobos-Gómez 1, Jonahtan Luna-García 1, Alma Gámez-Varela 1, Miguel Martínez-Rodríguez 1, Hugo López-Briones 1, Eréndira Chávez-González 1, Latin American CDH Study GroupAffiliations expand

Abstract

Objective: To evaluate survival outcomes of fetuses with right sided congenital diaphragmatic hernia (CDH) treated in Latin American centres and to assess the utility of left lung area to predict neonatal survival.

Methods: A retrospective cohort including isolated right sided CDH cases managed expectantly during pregnancy in six tertiary centers from five Latin American countries. The utility of the observed/expected lung-to-head ratio (O/E-LHR) in predicting neonatal survival was assessed, and the best cut-off to predict prognosis was automatically selected by decision tree analysis.

Results: A total of 99 right sided CDH cases were recruited, 58 isolated fetuses were selected at a median gestational age of 26.2 weeks, showing an overall survival rate of 26.2%. A linear trend was observed between survival and the O/E-LHR, showing that at higher O/E-LHR, the greater probability of survival (r = 0.56, p < 0.001). O/E-LHR discriminates two groups with different survival outcomes: fetuses with an O/E-LHR ≥65% showed a significantly higher survival rate than those with an O/E-LHR <65% (81.8% vs. 15.6%, p < 0.01).

Conclusions: Overall survival rate in right sided CDH is lower in Latin American countries. The severity category of pulmonary hypoplasia should be classified according to lung area and the survival rate in such population.

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