Jani J, Nicolaides K H, Benachi A, Moreno O, Favre R, Gratacos E, Deprest J
Fetal Medicine Units of University Hospital Gasthuisberg, Leuven, Belgium.
Ultrasound Obstet Gynecol. 2008 Jan;31(1):37-40. doi: 10.1002/uog.5198.
To investigate whether the prediction of postnatal outcome of fetuses with isolated congenital diaphragmatic hernia depends on the gestational age at assessment using the fetal observed to expected (O/E) lung area to head circumference ratio (LHR), by comparing the performance of the test at 22-23 weeks with that at 32-33 weeks of gestation.
Following prenatal diagnosis of isolated diaphragmatic hernia before 22 weeks, we evaluated the O/E LHR at 22-32 weeks and again at 32-33 weeks of gestation. Only cases liveborn beyond 34 weeks of gestation and with postnatal follow-up available until discharge from the hospital were included. Regression analysis was used to examine the effect on postnatal survival of O/E LHR, gestational age at delivery, side of the diaphragmatic hernia and intrathoracic position of the liver. Wilcoxon rank test for paired samples was used to compare median O/E LHR at 22-23 weeks and 32-33 weeks, in babies who survived and in those who died. Receiver-operating characteristics (ROC) curves were constructed for the prediction of survival by O/E LHR at 22-23 weeks and at 32-33 weeks.
In total, 53 pairs of measurements could be assessed. Univariate logistic regression analysis demonstrated that significant predictors of survival were the presence or absence of intrathoracic herniation of the liver, the O/E LHR at 22-23 weeks and the O/E LHR at 32-33 weeks of gestation. Multivariate logistic regression analysis demonstrated that only O/E LHR at 22-23 weeks or 32-33 weeks provided significant independent prediction of survival. The median O/E LHR at 22-23 weeks was not significantly different from that at 32-23 weeks either in survivors or in babies that subsequently died in the neonatal period (P = 0.25 and P = 0.09, respectively). The area under the ROC curve for prediction of postnatal survival from the O/E LHR at 22-23 weeks was 0.789 (P < 0.001) and that for prediction from the O/E LHR at 32-33 weeks was 0.842 (P < 0.001).
In isolated diaphragmatic hernia, O/E LHR measurement at 22-23 weeks as well as at 32-33 weeks provides useful independent prediction of subsequent survival. The prediction of postnatal survival using O/E LHR is independent of the timing of assessment.
通过比较孕22 - 23周与孕32 - 33周时胎儿观察到的与预期的（O/E）肺面积与头围比值（LHR）对孤立性先天性膈疝胎儿产后结局的预测情况，研究预测是否取决于评估时的孕周。
在孕22周前对孤立性膈疝进行产前诊断后，我们在孕22 - 32周以及孕32 - 33周时评估O/E LHR。仅纳入孕周超过34周且有产后随访直至出院的活产病例。采用回归分析来检验O/E LHR、分娩时的孕周、膈疝的侧别以及肝脏的胸腔内位置对产后生存的影响。采用配对样本的Wilcoxon秩和检验来比较存活婴儿和死亡婴儿在孕22 - 23周和32 - 33周时的O/E LHR中位数。构建孕22 - 23周和32 - 33周时O/E LHR预测生存的受试者工作特征（ROC）曲线。
总共可评估53对测量值。单因素逻辑回归分析表明，生存的显著预测因素是肝脏胸腔内疝的有无、孕22 - 23周时的O/E LHR以及孕32 - 33周时的O/E LHR。多因素逻辑回归分析表明，仅孕22 - 23周或32 - 33周时的O/E LHR能提供对生存的显著独立预测。在存活者以及随后在新生儿期死亡的婴儿中，孕22 - 23周时的O/E LHR中位数与32 - 23周时的中位数无显著差异（分别为P = 0.25和P = 0.09）。孕22 - 23周时O/E LHR预测产后生存的ROC曲线下面积为0.789（P < 0.001），孕32 - 33周时预测的曲线下面积为0.842（P < 0.001）。
在孤立性膈疝中，孕22 - 23周以及孕32 - 33周时测量O/E LHR能为后续生存提供有用的独立预测。使用O/E LHR预测产后生存与评估时间无关。
