Congenital diaphragmatic hernia: lung-to-head ratio and lung volume for prediction of outcome

Am J Obstet Gynecol. 2011 Jul;205(1):43.e1-8. doi: 10.1016/j.ajog.2011.02.050. Epub 2011 Feb 23.


Objective: The purpose of this study was to evaluate observed/expected (O/E) lung-to-head ratio (LHR) by ultrasound (US) and total fetal lung volume (TFLV) by magnetic resonance imaging as neonatal outcome predictors in isolated fetal congenital diaphragmatic hernia (CDH).

Study design: We conducted a retrospective study of 72 fetuses with isolated CDH, in whom O/E LHR and TFLV were evaluated as survival predictors.

Results: O/E LHR on US and O/E TFLV by magnetic resonance imaging were significantly lower in newborn infants with isolated CDH who died compared with survivors (30.3 ± 8.3 vs 44.2 ± 14.2; P < .0001 for O/E LHR; 21.9 ± 6.3 vs 41.5 ± 17.6; P = .001 for O/E TFLV). Area under receiver-operator characteristics curve for survival for O/E LHR was 0.80 (95% confidence interval, 0.70-0.90). On multivariate analysis, O/E LHR predicted survival, whereas hernia side and first neonatal pH did not. For each unit increase in O/E LHR, mortality odds decreased by 11% (95% confidence interval, 4-17%).

Conclusion: In fetuses with isolated CDH, O/E LHR (US) independently predicts survival and may predict severity, allowing management to be optimized.

MeSH terms

  • Female
  • Head / diagnostic imaging*
  • Hernia, Diaphragmatic / diagnostic imaging
  • Hernia, Diaphragmatic / mortality
  • Hernias, Diaphragmatic, Congenital*
  • Humans
  • Infant, Newborn
  • Lung / abnormalities
  • Lung / diagnostic imaging*
  • Lung Volume Measurements
  • Magnetic Resonance Imaging
  • Male
  • Organ Size
  • Predictive Value of Tests
  • Pregnancy
  • Pregnancy Complications / diagnostic imaging
  • Pregnancy Complications / mortality
  • Severity of Illness Index
  • Treatment Outcome
  • Ultrasonography