Rate of increase of lung-to-head ratio over the course of gestation is predictive of survival in left-sided congenital diaphragmatic hernia

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• 作者：Emily A. Partridge ; William H. Peranteau ; Lisa Herkert ; Natalie E. Rintoul ; Alan W. Flake ; N. Scott Adzick ; Holly L. Hedrick ; ^{Hedrick@email.chop.edu" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Congenital diaphragmatic hernia ; Lung-to-head circumference ratio ; Prognosis
• 刊名：Journal of Pediatric Surgery
• 出版年：2016
• 出版时间：May 2016
• 年：2016
• 卷：51
• 期：5
• 页码：703-705
• 全文大小：219 K

文摘

Congenital diaphragmatic hernia (CDH) is associated with high postnatal mortality because of pulmonary hypoplasia. The prognostic utility of serial lung-to-head circumference measurements as a marker of lung growth has not been described. Our objective was to examine the relationship between the rate of interval increase of LHR and postnatal survival in left-sided CDH.

absSec_2">an class="sansserif">Methodsan>

We retrospectively reviewed charts of all left-sided CDH patients from January 2004 to July 2014. All ultrasound studies performed at our institution (n = 473) were reviewed. Categorical and continuous data were analyzed by chi-square and Mann&ndash;Whitney t-test, respectively, and slope analysis was performed by linear regression analysis (p < 0.05).

absSec_3">an class="sansserif">Resultsan>

A total of 226 patients were studied, with 154 long-term survivors and 72 non-survivors. Established markers of CDH severity, including intrathoracic liver position and requirement for patch repair, were significantly increased in non-survivors (p < 0.0001). The rate of LHR increase as measured by linear regression and slope analysis was significantly increased in long-term survivors (p = 0.0175).

absSec_4">an class="sansserif">Conclusionsan>

Our findings indicate that the interval increase in LHR levels over the course of gestation correlate with survival in left-sided CDH patients. Regular ultrasonographic re-evaluation of LHR throughout gestation following diagnosis of CDH may provide prognostic insight and help guide patient management.