Prenatal predictors of mortality in fetuses with congenital diaphragmatic hernia: a systematic review and meta-analysis

Kazunori Masahata, Masaya Yamoto, Satoshi Umeda, Kouji Nagata, Keita Terui, Makoto Fujii, Masayuki Shiraishi, Masahiro Hayakawa, Shoichiro Amari, Kouji Masumoto, Tadaharu Okazaki, Noboru Inamura, Katsuaki Toyoshima, Yuki Koike, Taizo Furukawa, Yuta Yazaki, Akiko Yokoi, Masayuki Endo, Yuko Tazuke, Hiroomi OkuyamaNoriaki Usui

Research output: Contribution to journalArticlepeer-review


Purpose: This study aimed to evaluate prenatal predictors of mortality in fetuses with congenital diaphragmatic hernia (CDH). Methods: A systematic literature search was performed to identify relevant observational studies that evaluated the ability of lung-to-head ratio (LHR), observed-to-expected LHR (o/e-LHR), observed-to-expected total fetal lung volume (o/e-TFLV), lung-to-thorax transverse area ratio (L/T ratio), intrathoracic herniation of the liver and the stomach, and side of diaphragmatic hernia, using a threshold for the prediction of mortality in fetuses with CDH. Study quality was assessed using the QUADAS-2 tool. Hierarchical summary receiver operating characteristic curves were constructed. Results: A total of 50 articles were included in this meta-analysis. The QUADAS-2 tool identified a high risk of bias in more than one domain scored in all parameters. Among those parameters, the diagnostic odds ratio of mortality with o/e-LHR < 25%, o/e-TFLV < 25%, and L/T ratio < 0.08 were 11.98 [95% confidence interval (CI) 4.65–30.89], 11.14 (95% CI 5.19–23.89), and 10.28 (95% CI 3.38–31.31), respectively. The predictive values for mortality were similar between the presence of liver herniation and retrocardiac fetal stomach position. Conclusions: This systematic review suggests that o/e-LHR, o/e-TFLV, and L/T ratio are equally good predictors of neonatal mortality in fetuses with isolated CDH.

Original languageEnglish
Pages (from-to)1745-1757
Number of pages13
JournalPediatric surgery international
Issue number12
Publication statusPublished - Dec 2022

All Science Journal Classification (ASJC) codes

  • Surgery
  • Pediatrics, Perinatology, and Child Health


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