The lung-to-thorax transverse area ratio at term and near term correlates with survival in isolated congenital diaphragmatic hernia

Kiyomi Tsukimori, Kouji Masumoto, Seiichi Morokuma, Takazumi Yoshimura, Tomoaki Taguchi, Toshiro Hara, Yoshiro Sakaguchi, Shosuke Takahashi, Norio Wake, Sachiyo Suita

Research output: Contribution to journalReview article

15 Citations (Scopus)

Abstract

Objective. The purpose of this study was to determine how well liver position, the lung area-to-head circumference (L/H) ratio, and the lung-to-thorax transverse area (L/T) ratio predicted the need for extracorporeal membrane oxygenation (EC MO) and survival in fetuses with isolated congenital diaphragmatic hernia (CDH). Methods. Antenatal records of 25 fetuses with isolated left-sided CDH who were born by cesarean delivery under fetal stabilization at this institution were reviewed. The latest determinations of the L/H and L/T ratios before birth (between 34 and 38 weeks' gestation) were compared on the basis of the cutoff points for mortality: less than 1.0 versus 1.0 or greater for the L/H ratio and 0.08 or less versus greater than 0.08 for the L/T ratio. Outcome measures assessed were survival (discharge to home) and the need for ECMO. Results. Overall survival was 64% (16/25). Postnatal survival in fetuses with an L/T ratio of 0.08 or less was statistically lower than in those with an L/T ratio of greater than 0.08 (33% versus 81%; P = .0308). The percentage requiring ECMO in the group with an L/T ratio of 0.08 or less was also higher than that of the group with an L/T ratio of greater than 0.08, but the difference was not statistically significant (67% versus 25%; P = .0872). Neither the L/H ratio nor herniation of the fetal liver into the chest affected survival or the need for ECMO. Conclusions. In fetuses with isolated CDH at term or near term, the L/T ratio may be a better predictor of outcome than the L/H ratio or liver herniation.

Original languageEnglish
Pages (from-to)707-713
Number of pages7
JournalJournal of Ultrasound in Medicine
Volume27
Issue number5
DOIs
Publication statusPublished - Jan 1 2008

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thorax
lungs
fetuses
Fetus
Thorax
Lung
liver
Liver
Extracorporeal Membrane Oxygenation
circumferences
mortality
chest
oxygenation
Head
Outcome Assessment (Health Care)
Parturition
delivery
Pregnancy
cut-off
stabilization

All Science Journal Classification (ASJC) codes

  • Radiological and Ultrasound Technology
  • Radiology Nuclear Medicine and imaging

Cite this

The lung-to-thorax transverse area ratio at term and near term correlates with survival in isolated congenital diaphragmatic hernia. / Tsukimori, Kiyomi; Masumoto, Kouji; Morokuma, Seiichi; Yoshimura, Takazumi; Taguchi, Tomoaki; Hara, Toshiro; Sakaguchi, Yoshiro; Takahashi, Shosuke; Wake, Norio; Suita, Sachiyo.

In: Journal of Ultrasound in Medicine, Vol. 27, No. 5, 01.01.2008, p. 707-713.

Research output: Contribution to journalReview article

Tsukimori, Kiyomi ; Masumoto, Kouji ; Morokuma, Seiichi ; Yoshimura, Takazumi ; Taguchi, Tomoaki ; Hara, Toshiro ; Sakaguchi, Yoshiro ; Takahashi, Shosuke ; Wake, Norio ; Suita, Sachiyo. / The lung-to-thorax transverse area ratio at term and near term correlates with survival in isolated congenital diaphragmatic hernia. In: Journal of Ultrasound in Medicine. 2008 ; Vol. 27, No. 5. pp. 707-713.
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abstract = "Objective. The purpose of this study was to determine how well liver position, the lung area-to-head circumference (L/H) ratio, and the lung-to-thorax transverse area (L/T) ratio predicted the need for extracorporeal membrane oxygenation (EC MO) and survival in fetuses with isolated congenital diaphragmatic hernia (CDH). Methods. Antenatal records of 25 fetuses with isolated left-sided CDH who were born by cesarean delivery under fetal stabilization at this institution were reviewed. The latest determinations of the L/H and L/T ratios before birth (between 34 and 38 weeks' gestation) were compared on the basis of the cutoff points for mortality: less than 1.0 versus 1.0 or greater for the L/H ratio and 0.08 or less versus greater than 0.08 for the L/T ratio. Outcome measures assessed were survival (discharge to home) and the need for ECMO. Results. Overall survival was 64{\%} (16/25). Postnatal survival in fetuses with an L/T ratio of 0.08 or less was statistically lower than in those with an L/T ratio of greater than 0.08 (33{\%} versus 81{\%}; P = .0308). The percentage requiring ECMO in the group with an L/T ratio of 0.08 or less was also higher than that of the group with an L/T ratio of greater than 0.08, but the difference was not statistically significant (67{\%} versus 25{\%}; P = .0872). Neither the L/H ratio nor herniation of the fetal liver into the chest affected survival or the need for ECMO. Conclusions. In fetuses with isolated CDH at term or near term, the L/T ratio may be a better predictor of outcome than the L/H ratio or liver herniation.",
author = "Kiyomi Tsukimori and Kouji Masumoto and Seiichi Morokuma and Takazumi Yoshimura and Tomoaki Taguchi and Toshiro Hara and Yoshiro Sakaguchi and Shosuke Takahashi and Norio Wake and Sachiyo Suita",
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T1 - The lung-to-thorax transverse area ratio at term and near term correlates with survival in isolated congenital diaphragmatic hernia

AU - Tsukimori, Kiyomi

AU - Masumoto, Kouji

AU - Morokuma, Seiichi

AU - Yoshimura, Takazumi

AU - Taguchi, Tomoaki

AU - Hara, Toshiro

AU - Sakaguchi, Yoshiro

AU - Takahashi, Shosuke

AU - Wake, Norio

AU - Suita, Sachiyo

PY - 2008/1/1

Y1 - 2008/1/1

N2 - Objective. The purpose of this study was to determine how well liver position, the lung area-to-head circumference (L/H) ratio, and the lung-to-thorax transverse area (L/T) ratio predicted the need for extracorporeal membrane oxygenation (EC MO) and survival in fetuses with isolated congenital diaphragmatic hernia (CDH). Methods. Antenatal records of 25 fetuses with isolated left-sided CDH who were born by cesarean delivery under fetal stabilization at this institution were reviewed. The latest determinations of the L/H and L/T ratios before birth (between 34 and 38 weeks' gestation) were compared on the basis of the cutoff points for mortality: less than 1.0 versus 1.0 or greater for the L/H ratio and 0.08 or less versus greater than 0.08 for the L/T ratio. Outcome measures assessed were survival (discharge to home) and the need for ECMO. Results. Overall survival was 64% (16/25). Postnatal survival in fetuses with an L/T ratio of 0.08 or less was statistically lower than in those with an L/T ratio of greater than 0.08 (33% versus 81%; P = .0308). The percentage requiring ECMO in the group with an L/T ratio of 0.08 or less was also higher than that of the group with an L/T ratio of greater than 0.08, but the difference was not statistically significant (67% versus 25%; P = .0872). Neither the L/H ratio nor herniation of the fetal liver into the chest affected survival or the need for ECMO. Conclusions. In fetuses with isolated CDH at term or near term, the L/T ratio may be a better predictor of outcome than the L/H ratio or liver herniation.

AB - Objective. The purpose of this study was to determine how well liver position, the lung area-to-head circumference (L/H) ratio, and the lung-to-thorax transverse area (L/T) ratio predicted the need for extracorporeal membrane oxygenation (EC MO) and survival in fetuses with isolated congenital diaphragmatic hernia (CDH). Methods. Antenatal records of 25 fetuses with isolated left-sided CDH who were born by cesarean delivery under fetal stabilization at this institution were reviewed. The latest determinations of the L/H and L/T ratios before birth (between 34 and 38 weeks' gestation) were compared on the basis of the cutoff points for mortality: less than 1.0 versus 1.0 or greater for the L/H ratio and 0.08 or less versus greater than 0.08 for the L/T ratio. Outcome measures assessed were survival (discharge to home) and the need for ECMO. Results. Overall survival was 64% (16/25). Postnatal survival in fetuses with an L/T ratio of 0.08 or less was statistically lower than in those with an L/T ratio of greater than 0.08 (33% versus 81%; P = .0308). The percentage requiring ECMO in the group with an L/T ratio of 0.08 or less was also higher than that of the group with an L/T ratio of greater than 0.08, but the difference was not statistically significant (67% versus 25%; P = .0872). Neither the L/H ratio nor herniation of the fetal liver into the chest affected survival or the need for ECMO. Conclusions. In fetuses with isolated CDH at term or near term, the L/T ratio may be a better predictor of outcome than the L/H ratio or liver herniation.

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DO - 10.7863/jum.2008.27.5.707

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