Journal of pediatric surgery · 2026
Comparison of prenatal lung volume measurements associated with extracorporeal membrane oxygenation (ECMO) utilization and mortality in congenital diaphragmatic hernia.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод в очереди
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Stanic Philip, Gavulic Amelia, Jenkins Todd M, Brown Colton, Frischer Jason, Rymeski Beth, Lim Foong-Yen, Galganski Laura
Аннотация
BACKGROUND: Prenatal imaging plays a central role in risk stratification for congenital diaphragmatic hernia (CDH). We sought to identify the most accurate predictor of mortality and ECMO utilization at early and late gestation timepoints amongst the various lung volume measurements: lung-to-head ratio (LHR), observed-to-expected (O/E) LHR, O/E total fetal lung volume (TFLV) and percent predicted lung volume (PPLV).
METHODS: Retrospective cohort study of patients with isolated left and right-sided CDH at our fetal care center from 2012 to 2023. Early gestation imaging was performed at initial evaluation (median 24.6 weeks) and late gestation imaging between 32 and 34 weeks gestation. Receiver-operating characteristic (ROC) curve analysis was performed to establish optimal lung measurement cutoff values (Youden's index) associated with ECMO utilization and mortality.
RESULTS: For left CDH, late PPLV ≤17.6 % was the strongest predictor of ECMO utilization (AUC 0.93), while late PPLV ≤18.0 % was the strongest predictor of mortality (AUC 0.86). Early and late O/E TFLV were also strong predictors of both ECMO utilization (AUC 0.86) and mortality (AUC 0.80-0.82). For right CDH, late PPLV ≤16.4 % was the strongest predictor of ECMO utilization (AUC 0.96), whereas late O/E LHR ≤40.5 % was the strongest predictor of mortality (AUC 0.70). Other early lung metrics demonstrated moderate to poor predictive ability.
CONCLUSION: O/E TFLV is the best overall predictor of ECMO utilization and mortality in both early and late prenatal imaging. Late gestation PPLV is the best single predictor of ECMO utilization in left and right CDH and mortality in left CDH.
METHODS: Retrospective cohort study of patients with isolated left and right-sided CDH at our fetal care center from 2012 to 2023. Early gestation imaging was performed at initial evaluation (median 24.6 weeks) and late gestation imaging between 32 and 34 weeks gestation. Receiver-operating characteristic (ROC) curve analysis was performed to establish optimal lung measurement cutoff values (Youden's index) associated with ECMO utilization and mortality.
RESULTS: For left CDH, late PPLV ≤17.6 % was the strongest predictor of ECMO utilization (AUC 0.93), while late PPLV ≤18.0 % was the strongest predictor of mortality (AUC 0.86). Early and late O/E TFLV were also strong predictors of both ECMO utilization (AUC 0.86) and mortality (AUC 0.80-0.82). For right CDH, late PPLV ≤16.4 % was the strongest predictor of ECMO utilization (AUC 0.96), whereas late O/E LHR ≤40.5 % was the strongest predictor of mortality (AUC 0.70). Other early lung metrics demonstrated moderate to poor predictive ability.
CONCLUSION: O/E TFLV is the best overall predictor of ECMO utilization and mortality in both early and late prenatal imaging. Late gestation PPLV is the best single predictor of ECMO utilization in left and right CDH and mortality in left CDH.