Intrapulmonary artery Doppler to predict mortality and morbidity in fetuses with mild or moderate left-sided congenital diaphragmatic hernia.
Extracorporeal Membrane Oxygenation
/ statistics & numerical data
Female
Fetal Diseases
/ diagnostic imaging
Fetus
/ diagnostic imaging
Head
/ diagnostic imaging
Hernias, Diaphragmatic, Congenital
/ diagnostic imaging
Humans
Hypertension, Pulmonary
/ congenital
Infant, Newborn
Logistic Models
Lung
/ diagnostic imaging
Morbidity
Odds Ratio
Predictive Value of Tests
Pregnancy
Pulmonary Artery
/ diagnostic imaging
Pulsatile Flow
Retrospective Studies
Ultrasonography, Doppler
/ statistics & numerical data
Ultrasonography, Prenatal
/ statistics & numerical data
Doppler
congenital diaphragmatic hernia
morbidity
mortality
prediction
pulmonary hypertension
survival
Journal
Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology
ISSN: 1469-0705
Titre abrégé: Ultrasound Obstet Gynecol
Pays: England
ID NLM: 9108340
Informations de publication
Date de publication:
Oct 2021
Oct 2021
Historique:
revised:
17
04
2021
received:
22
02
2021
accepted:
21
05
2021
pubmed:
6
6
2021
medline:
15
12
2021
entrez:
5
6
2021
Statut:
ppublish
Résumé
In fetuses with isolated left-sided congenital diaphragmatic hernia (LCDH), prenatal detection of severe pulmonary hypoplasia is important, as fetal therapy can improve survival. Cases with mild or moderate lung hypoplasia still carry a considerable risk of mortality and morbidity, but there has been less interest in the accurate prediction of outcome in these cases. In this study of fetuses with mild or moderate isolated LCDH, we aimed to investigate: (1) the association between intrapulmonary artery (IPA) Doppler findings and mortality at discharge; (2) whether adding IPA Doppler findings improves the prediction of mortality based on lung size and liver herniation; and (3) the association between IPA Doppler findings and early neonatal morbidity. This was a retrospective study of all consecutive fetuses assessed at the BCNatal and UZ Leuven hospitals between 2008 and 2020 with a prenatal diagnosis of isolated, non-severe LCDH, defined as observed-to-expected lung-to-head ratio (o/e-LHR) > 25%, that were managed expectantly during pregnancy followed by standardized neonatal management. An additional inclusion criterion was the availability of IPA Doppler measurements. The primary outcome was the association between IPA Doppler findings and mortality at discharge. Other predictors included o/e-LHR, liver herniation and gestational age at birth. Secondary outcomes were the association between IPA Doppler findings and the presence of pulmonary hypertension (PHT), need for supplemental oxygen at discharge and need for extracorporeal membrane oxygenation. IPA pulsatility index (PI) values were converted into Z-scores. Logistic regression analysis was performed to investigate the associations between predictor variables and outcome, and the best model was chosen based on the Nagelkerke R Observations for 70 non-severe LCDH cases were available. Fifty-four (77%) fetuses survived until discharge. On logistic regression analysis, higher IPA-PI was associated with an increased risk of mortality (odds ratio (OR), 3.96 (95% CI, 1.62-9.70)), independently of o/e-LHR (OR, 0.87 (95% CI, 0.79-0.97)). An IPA-PI Z-score cut-off of 1.8 predicted mortality with a detection rate of 69% and specificity of 93%. Adding IPA-PI to o/e-LHR improved significantly the model's performance (Nagelkerke R In fetuses with mild or moderate LCDH, IPA-PI was associated with mortality and morbidity, independently of lung size. A model combining o/e-LHR with IPA-PI identified up to four in five cases that eventually died, despite being considered to have non-severe pulmonary hypoplasia. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
590-596Subventions
Organisme : Erasmus +
ID : 2013-0040
Organisme : Great Ormond Street Hospital Charity Fund
Informations de copyright
© 2021 International Society of Ultrasound in Obstetrics and Gynecology.
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