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Research: Prenatal predictors of mortality in fetuses with congenital diaphragmatic hernia: a systematic review and meta-analysis

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Research: Prenatal predictors of mortality in fetuses with congenital diaphragmatic hernia: a systematic review and meta-analysis

Pediatr Surg Int

. 2022 Sep 14.

 doi: 10.1007/s00383-022-05232-w. Online ahead of print. https://pubmed.ncbi.nlm.nih.gov/36102982/

Prenatal predictors of mortality in fetuses with congenital diaphragmatic hernia: a systematic review and meta-analysis

Kazunori Masahata # 1Masaya Yamoto # 2Satoshi Umeda # 3Kouji Nagata 4Keita Terui 5Makoto Fujii 6Masayuki Shiraishi 7Masahiro Hayakawa 8Shoichiro Amari 9Kouji Masumoto 10Tadaharu Okazaki 11Noboru Inamura 12Katsuaki Toyoshima 13Yuki Koike 14Taizo Furukawa 15Yuta Yazaki 16Akiko Yokoi 17Masayuki Endo 18Yuko Tazuke 19Hiroomi Okuyama 19Noriaki Usui 3

Affiliations expand

Abstract

Purpose: This study aimed to evaluate prenatal predictors of mortality in fetuses with congenital diaphragmatic hernia (CDH).

Methods: A systematic literature search was performed to identify relevant observational studies that evaluated the ability of lung-to-head ratio (LHR), observed-to-expected LHR (o/e-LHR), observed-to-expected total fetal lung volume (o/e-TFLV), lung-to-thorax transverse area ratio (L/T ratio), intrathoracic herniation of the liver and the stomach, and side of diaphragmatic hernia, using a threshold for the prediction of mortality in fetuses with CDH. Study quality was assessed using the QUADAS-2 tool. Hierarchical summary receiver operating characteristic curves were constructed.

Results: A total of 50 articles were included in this meta-analysis. The QUADAS-2 tool identified a high risk of bias in more than one domain scored in all parameters. Among those parameters, the diagnostic odds ratio of mortality with o/e-LHR < 25%, o/e-TFLV < 25%, and L/T ratio < 0.08 were 11.98 [95% confidence interval (CI) 4.65-30.89], 11.14 (95% CI 5.19-23.89), and 10.28 (95% CI 3.38-31.31), respectively. The predictive values for mortality were similar between the presence of liver herniation and retrocardiac fetal stomach position.

Conclusions: This systematic review suggests that o/e-LHR, o/e-TFLV, and L/T ratio are equally good predictors of neonatal mortality in fetuses with isolated CDH.

Keywords: Congenital diaphragmatic hernia; Fetal lung volume; Liver herniation; Lung to head ratio; Lung to thorax transverse area ratio; Prenatal diagnosis.

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