Prenatal MRI fetal lung volumes and percent liver herniation predict pulmonary morbidity in congenital diaphragmatic hernia (CDH)

Irving J. Zamora, Oluyinka O. Olutoye, Darrell L. Cass, Sara C. Fallon, David A. Lazar, Christopher I. Cassady, Amy R. Mehollin-Ray, Stephen E. Welty, Rodrigo Ruano, Michael A. Belfort, Timothy C. Lee

Research output: Contribution to journalArticle

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Abstract

Purpose The purpose of this study was to determine whether prenatal imaging parameters are predictive of postnatal CDH-associated pulmonary morbidity. Methods The records of all neonates with CDH treated from 2004 to 2012 were reviewed. Patients requiring supplemental oxygen at 30 days of life (DOL) were classified as having chronic lung disease (CLD). Fetal MRI-measured observed/expected total fetal lung volume (O/E-TFLV) and percent liver herniation (%LH) were recorded. Receiver operating characteristic (ROC) curves and multivariate regression were applied to assess the prognostic value of O/E-TFLV and %LH for development of CLD. Results Of 172 neonates with CDH, 108 had fetal MRIs, and survival was 76%. 82% (89/108) were alive at DOL 30, 46 (52%) of whom had CLD. Neonates with CLD had lower mean O/E-TFLV (30vs.42%; p = 0.001) and higher %LH (21.3 ± 2.8 vs.7.1 ± 1.8%; p < 0.001) compared to neonates without CLD. Using ROC analysis, the best cutoffs in predicting CLD were an O/E-TFLV < 35% (AUC = 0.74; p < 0.001) and %LH > 20% (AUC =0.78; p < 0.001). On logistic regression, O/E-TFLV < 35% and a %LH > 20% were highly associated with indicators of long-term pulmonary sequelae. On multivariate analysis, %LH was the strongest predictor of CLD in patients with CDH (OR: 10.96, 95%CI: 2.5-48.9, p = 0.002). Conclusion Prenatal measurement of O/E-TFLV and %LH is predictive of CDH pulmonary morbidity and can aid in establishing parental expectations of postnatal outcomes.

Original languageEnglish (US)
Pages (from-to)688-693
Number of pages6
JournalJournal of Pediatric Surgery
Volume49
Issue number5
DOIs
StatePublished - Jan 1 2014
Externally publishedYes

Fingerprint

Morbidity
Lung Diseases
Lung
Chronic Disease
Liver
Newborn Infant
Congenital Diaphragmatic Hernias
ROC Curve
Area Under Curve
Multivariate Analysis
Oxygen
Survival

Keywords

  • CDH
  • Congenital diaphragmatic hernia
  • Fetal lung volumes
  • Fetal magnetic resonance imaging
  • Fetal predictors
  • Morbidity
  • Mortality
  • Prenatal diagnosis

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health
  • Medicine(all)

Cite this

Prenatal MRI fetal lung volumes and percent liver herniation predict pulmonary morbidity in congenital diaphragmatic hernia (CDH). / Zamora, Irving J.; Olutoye, Oluyinka O.; Cass, Darrell L.; Fallon, Sara C.; Lazar, David A.; Cassady, Christopher I.; Mehollin-Ray, Amy R.; Welty, Stephen E.; Ruano, Rodrigo; Belfort, Michael A.; Lee, Timothy C.

In: Journal of Pediatric Surgery, Vol. 49, No. 5, 01.01.2014, p. 688-693.

Research output: Contribution to journalArticle

Zamora, IJ, Olutoye, OO, Cass, DL, Fallon, SC, Lazar, DA, Cassady, CI, Mehollin-Ray, AR, Welty, SE, Ruano, R, Belfort, MA & Lee, TC 2014, 'Prenatal MRI fetal lung volumes and percent liver herniation predict pulmonary morbidity in congenital diaphragmatic hernia (CDH)', Journal of Pediatric Surgery, vol. 49, no. 5, pp. 688-693. https://doi.org/10.1016/j.jpedsurg.2014.02.048
Zamora, Irving J. ; Olutoye, Oluyinka O. ; Cass, Darrell L. ; Fallon, Sara C. ; Lazar, David A. ; Cassady, Christopher I. ; Mehollin-Ray, Amy R. ; Welty, Stephen E. ; Ruano, Rodrigo ; Belfort, Michael A. ; Lee, Timothy C. / Prenatal MRI fetal lung volumes and percent liver herniation predict pulmonary morbidity in congenital diaphragmatic hernia (CDH). In: Journal of Pediatric Surgery. 2014 ; Vol. 49, No. 5. pp. 688-693.
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abstract = "Purpose The purpose of this study was to determine whether prenatal imaging parameters are predictive of postnatal CDH-associated pulmonary morbidity. Methods The records of all neonates with CDH treated from 2004 to 2012 were reviewed. Patients requiring supplemental oxygen at 30 days of life (DOL) were classified as having chronic lung disease (CLD). Fetal MRI-measured observed/expected total fetal lung volume (O/E-TFLV) and percent liver herniation ({\%}LH) were recorded. Receiver operating characteristic (ROC) curves and multivariate regression were applied to assess the prognostic value of O/E-TFLV and {\%}LH for development of CLD. Results Of 172 neonates with CDH, 108 had fetal MRIs, and survival was 76{\%}. 82{\%} (89/108) were alive at DOL 30, 46 (52{\%}) of whom had CLD. Neonates with CLD had lower mean O/E-TFLV (30vs.42{\%}; p = 0.001) and higher {\%}LH (21.3 ± 2.8 vs.7.1 ± 1.8{\%}; p < 0.001) compared to neonates without CLD. Using ROC analysis, the best cutoffs in predicting CLD were an O/E-TFLV < 35{\%} (AUC = 0.74; p < 0.001) and {\%}LH > 20{\%} (AUC =0.78; p < 0.001). On logistic regression, O/E-TFLV < 35{\%} and a {\%}LH > 20{\%} were highly associated with indicators of long-term pulmonary sequelae. On multivariate analysis, {\%}LH was the strongest predictor of CLD in patients with CDH (OR: 10.96, 95{\%}CI: 2.5-48.9, p = 0.002). Conclusion Prenatal measurement of O/E-TFLV and {\%}LH is predictive of CDH pulmonary morbidity and can aid in establishing parental expectations of postnatal outcomes.",
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author = "Zamora, {Irving J.} and Olutoye, {Oluyinka O.} and Cass, {Darrell L.} and Fallon, {Sara C.} and Lazar, {David A.} and Cassady, {Christopher I.} and Mehollin-Ray, {Amy R.} and Welty, {Stephen E.} and Rodrigo Ruano and Belfort, {Michael A.} and Lee, {Timothy C.}",
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TY - JOUR

T1 - Prenatal MRI fetal lung volumes and percent liver herniation predict pulmonary morbidity in congenital diaphragmatic hernia (CDH)

AU - Zamora, Irving J.

AU - Olutoye, Oluyinka O.

AU - Cass, Darrell L.

AU - Fallon, Sara C.

AU - Lazar, David A.

AU - Cassady, Christopher I.

AU - Mehollin-Ray, Amy R.

AU - Welty, Stephen E.

AU - Ruano, Rodrigo

AU - Belfort, Michael A.

AU - Lee, Timothy C.

PY - 2014/1/1

Y1 - 2014/1/1

N2 - Purpose The purpose of this study was to determine whether prenatal imaging parameters are predictive of postnatal CDH-associated pulmonary morbidity. Methods The records of all neonates with CDH treated from 2004 to 2012 were reviewed. Patients requiring supplemental oxygen at 30 days of life (DOL) were classified as having chronic lung disease (CLD). Fetal MRI-measured observed/expected total fetal lung volume (O/E-TFLV) and percent liver herniation (%LH) were recorded. Receiver operating characteristic (ROC) curves and multivariate regression were applied to assess the prognostic value of O/E-TFLV and %LH for development of CLD. Results Of 172 neonates with CDH, 108 had fetal MRIs, and survival was 76%. 82% (89/108) were alive at DOL 30, 46 (52%) of whom had CLD. Neonates with CLD had lower mean O/E-TFLV (30vs.42%; p = 0.001) and higher %LH (21.3 ± 2.8 vs.7.1 ± 1.8%; p < 0.001) compared to neonates without CLD. Using ROC analysis, the best cutoffs in predicting CLD were an O/E-TFLV < 35% (AUC = 0.74; p < 0.001) and %LH > 20% (AUC =0.78; p < 0.001). On logistic regression, O/E-TFLV < 35% and a %LH > 20% were highly associated with indicators of long-term pulmonary sequelae. On multivariate analysis, %LH was the strongest predictor of CLD in patients with CDH (OR: 10.96, 95%CI: 2.5-48.9, p = 0.002). Conclusion Prenatal measurement of O/E-TFLV and %LH is predictive of CDH pulmonary morbidity and can aid in establishing parental expectations of postnatal outcomes.

AB - Purpose The purpose of this study was to determine whether prenatal imaging parameters are predictive of postnatal CDH-associated pulmonary morbidity. Methods The records of all neonates with CDH treated from 2004 to 2012 were reviewed. Patients requiring supplemental oxygen at 30 days of life (DOL) were classified as having chronic lung disease (CLD). Fetal MRI-measured observed/expected total fetal lung volume (O/E-TFLV) and percent liver herniation (%LH) were recorded. Receiver operating characteristic (ROC) curves and multivariate regression were applied to assess the prognostic value of O/E-TFLV and %LH for development of CLD. Results Of 172 neonates with CDH, 108 had fetal MRIs, and survival was 76%. 82% (89/108) were alive at DOL 30, 46 (52%) of whom had CLD. Neonates with CLD had lower mean O/E-TFLV (30vs.42%; p = 0.001) and higher %LH (21.3 ± 2.8 vs.7.1 ± 1.8%; p < 0.001) compared to neonates without CLD. Using ROC analysis, the best cutoffs in predicting CLD were an O/E-TFLV < 35% (AUC = 0.74; p < 0.001) and %LH > 20% (AUC =0.78; p < 0.001). On logistic regression, O/E-TFLV < 35% and a %LH > 20% were highly associated with indicators of long-term pulmonary sequelae. On multivariate analysis, %LH was the strongest predictor of CLD in patients with CDH (OR: 10.96, 95%CI: 2.5-48.9, p = 0.002). Conclusion Prenatal measurement of O/E-TFLV and %LH is predictive of CDH pulmonary morbidity and can aid in establishing parental expectations of postnatal outcomes.

KW - CDH

KW - Congenital diaphragmatic hernia

KW - Fetal lung volumes

KW - Fetal magnetic resonance imaging

KW - Fetal predictors

KW - Morbidity

KW - Mortality

KW - Prenatal diagnosis

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