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Research: Variability in antenatal prognostication of diaphragmatic hernia across the North American Fetal Therapy Network.


Research: Variability in antenatal prognostication of diaphragmatic hernia across the North American Fetal Therapy Network.

Prenat Diagn. 2019 Oct 10. doi: 10.1002/pd.5560. [Epub ahead of print]


Variability in antenatal prognostication of diaphragmatic hernia across the North American Fetal Therapy Network.

Abbasi N1Sanz Cortes M2Ruano R3Johnson A4Morgan T5Coleman B6Baschat A7Zaretsky M8Lim FY9Bulas D10Benachi A11,12Ryan G1NAFTNet and the Fetal Endoscopic Tracheal Occlusion (FETO) consortium*.

Author information

1Fetal Medicine Unit, Ontario Fetal Centre, Mount Sinai Hospital, University of Toronto, Canada.2Baylor College of Medicine, Dept. of Obstetrics & Gynecology, Texas Children’s Fetal Center, Houston, TX, USA.3Division of Maternal-Fetal Medicine, Dept. of Obstetrics & Gynecology, Mayo Clinic, College of Medicine, Rochester, MN, USA.4The Fetal Center, Children’s Memorial Hermann Hospital, University of Texas Health Science Center, Houston, TX, USA.5The Fetal Treatment Center, Department of Radiology, University of California, San Francisco, CA, USA.6Center for Fetal Diagnosis and Treatment at the Children’s Hospital of Philadelphia and Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA.7Center for Fetal Therapy, Department of Gynecology & Obstetrics, Johns Hopkins University School of Medicine; Baltimore, MD, USA.8Colorado Fetal Care Center, Colorado Children’s Hospital, University of Colorado, Aurora, CO, USA.9Fetal Care Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH.10Children’s National Medical System, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.11Centre Maladie Rare: Hernie de Coupole Diaphragmatique, Hôpital Antoine-Béclère, Clamart, France.12Service de Gynécologie-Obstétrique, AP-HP, Hôpital Antoine Béclère, Université Paris-Sud, Clamart, France.



To evaluate variability in antenatal sonographic prognostication of congenital diaphragmatic hernia (CDH) within the North American Fetal Therapy Network (NAFTNet).


NAFTNet centres were invited to complete a questionnaire and participate in videoconference calls, during which participants were observed while measuring lung area using the anteroposterior (AP), longest and trace method. Each centre identified 1-2 experienced fetal medicine or medical imaging specialists locally. Practices were compared among NAFTNet centres within and without the fetal endoscopic tracheal occlusion (FETO) consortium.


Nineteen participants from 9 FETO centres and 30 participants from 17 non-FETO centers completed the survey and 31 participants were observed. All centres measured observed-to-expected lung-to-head ratio (o/e LHR) or LHR for CDH prognostication. Image selection criteria for lung area measurement was consistent, including an axial section of the chest with clear lung borders and a 4-chamber cardiac view. Lung area measurement methods varied across NAFTNet, with most centers using longest (4/9 FETO vs. 13/29 non-FETO) or trace (3/9 FETO vs. 11/29 non-FETO). Centres differed in expected reference ranges for o/e LHR determination and whether the lowest, highest or average o/e LHR was used.


Variability in antenatal sonographic prognostication of CDH was identified across NAFTNet, indicating a need for consensus-based standardization.

This article is protected by copyright. All rights reserved.PMID: 31600412 DOI: 10.1002/pd.5560

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