Improving the prediction of neonatal outcomes in isolated left-sided congenital diaphragmatic hernia by direct and indirect sonographic assessment of liver herniation

Nicolas Sananes, Ingrid Britto, Adesola C. Akinkuotu, Oluyinka O. Olutoye, Darrell L. Cass, Haleh Sangi-Haghpeykar, Timothy C. Lee, Christopher I. Cassady, Amy Mehollin-Ray, Stephen Welty, Caraciolo Fernandes, Michael A. Belfort, Wesley Lee, Rodrigo Ruano

Research output: Contribution to journalArticle

12 Scopus citations

Abstract

Objectives-Liver herniation can be assessed sonographically by either a direct (liver-tothoracic area ratio) or an indirect (stomach position) method. Our objective was to evaluate the utility of those methods to assess liver herniation for the prediction of neonatal outcomes in patients with isolated left-sided congenital diaphragmatic hernia (CDH). Methods-We conducted a retrospective cohort study of all patients with CDH who had prenatal assessment and were delivered at Texas Children's Hospital between January 2004 and April 2014. The predictive value of sonographic parameters for mortality and the need for extracorporeal membrane oxygenation was evaluated by univariate, multivariate, and factor analysis and by receiver operating characteristics curves. Results-A total of 77 fetuses with isolated left-sided CDH were analyzed. The lung-tohead ratio, liver-to-thorax ratio, and stomach position (according to the classifications of Kitano et al [Ultrasound Obstet Gynecol 2011; 37:277-282] and Cordier et al [J Matern Fetal Neonatal Med 2015; 28:190-195]) were significantly associated with both neonatal outcomes (P< .03). Significant correlations were observed between all of these sonographic parameters. A combination of the liver-to-thorax ratio and stomach position (Kitano) or stomach position (Cordier) with the lung-to-head ratio increased the area under the receiver operating characteristic curve of the lung-to-head ratio for mortality prediction (0.86 [95% confidence interval, 0.74-0.98], 0.83 [0.72-0.95], and 0.83 [0.74-0.92], respectively). Conclusions-Sonographic measurements of liver herniation (liver-to-thorax ratio and stomach position) are predictive of neonatal outcomes in isolated left-sided congenital diaphragmatic hernia. Our study shows that the combination of those sonographic measurements of liver herniation and lung size improves the accuracy of predicting mortality in those fetuses.

Original languageEnglish (US)
Pages (from-to)1437-1443
Number of pages7
JournalJournal of Ultrasound in Medicine
Volume35
Issue number7
DOIs
StatePublished - Jul 1 2016
Externally publishedYes

Keywords

  • Congenital diaphragmatic hernia
  • Liver herniation
  • Lung-to-head ratio
  • Obstetric ultrasound
  • Prenatal predictors
  • Pulmonary hypoplasia
  • Stomach position

ASJC Scopus subject areas

  • Radiological and Ultrasound Technology
  • Radiology Nuclear Medicine and imaging

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    Sananes, N., Britto, I., Akinkuotu, A. C., Olutoye, O. O., Cass, D. L., Sangi-Haghpeykar, H., Lee, T. C., Cassady, C. I., Mehollin-Ray, A., Welty, S., Fernandes, C., Belfort, M. A., Lee, W., & Ruano, R. (2016). Improving the prediction of neonatal outcomes in isolated left-sided congenital diaphragmatic hernia by direct and indirect sonographic assessment of liver herniation. Journal of Ultrasound in Medicine, 35(7), 1437-1443. https://doi.org/10.7863/ultra.15.07020