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Review: Prenatal Assessment of Congenital Diaphragmatic Hernia at North American Fetal Therapy Network (NAFTNet) Centers: A Continued Plea for Standardization

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Review: Prenatal Assessment of Congenital Diaphragmatic Hernia at North American Fetal Therapy Network (NAFTNet) Centers: A Continued Plea for Standardization

Prenat Diagn

. 2020 Oct 30. doi: 10.1002/pd.5859. Online ahead of print. https://pubmed.ncbi.nlm.nih.gov/33125174/

Prenatal Assessment of Congenital Diaphragmatic Hernia at North American Fetal Therapy Network (NAFTNet) Centers: A Continued Plea for Standardization

Erin E Perrone 1Nimrah Abbasi 2Magdalena Sanz Cortes 3Uzma Umar 1Greg Ryan 2Anthony Johnson 4Maria Ladino-Torres 5Rodrigo Ruano 6North American Fetal Therapy Network (NAFTNet)Affiliations expand

Abstract

Introduction: Prenatal work-up for congenital diaphragmatic hernia (CDH) is important for risk stratification, standardization, counseling and optimal therapeutic choice. To determine current practice patterns regarding prenatal CDH work-up, including antenatal ultrasound and MRI use, and to identify areas for standardization of such evaluation between fetal centers.

Methods: A survey regarding prenatal CDH work-up was sent to each member center of the North American Fetal Therapy Network (NAFTNet) (n=36).

Results: All responded. Sonographic measurement of lung-to-head ratio (LHR) was determined by all, 89% (32/36) of which routinely calculate observed-to-expected LHR. The method for measuring LHR varied: 58% (21/36) used a “trace” method, 25% (9/36) used “longest axis”, and 17% (6/36) used an “antero-posterior” method. Fetal MRI was routinely used in 78% (28/36) of centers, but there was significant variability in fetal lung volume measurement. Whereas all generated a total fetal lung volume, the planes, methodology and references values varied significantly. All evaluated liver position, 71% (20/28) evaluated stomach position and 54% (15/28) quantified the degree of liver herniation. More consistency in workup was seen between centers offering fetal intervention.

Conclusion: Prenatal CDH work-up and management differs considerably amongst North American fetal diagnostic centers, highlighting a need for its standardization. This article is protected by copyright. All rights reserved.

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