Oluyomi-Obi Titilayo, Kuret Verena, Puligandla Pramod, Lodha Abhay, Lee-Robertson Helen, Lee Kovid, Somerset David, Johnson Joann, Ryan Greg
Section of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Calgary, Calgary, Alberta, Canada.
Section of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Calgary, Calgary, Alberta, Canada.
J Pediatr Surg. 2017 May;52(5):881-888. doi: 10.1016/j.jpedsurg.2016.12.008. Epub 2016 Dec 21.
Pulmonary hypoplasia is the main cause of mortality in isolated congenital diaphragmatic hernia (CDH) and its prediction is paramount when counseling parents. We sought to identify antenatal parameters that predicted neonatal mortality in CDH.
Search was conducted in MEDLINE, EMBASE, Cochrane Database of Systematic reviews, PubMed, Scopus, and Web of Science on the ability of lung-to-head ratio (LHR), observed-to-expected LHR (o/e LHR), total fetal lung volume (TFLV), o/e TFLV, percentage predicted lung volume (PPLV) and degree of liver herniation to predict neonatal morbidity and mortality in fetuses with CDH. Primary outcome was perinatal survival and secondary was the use of extracorporeal membrane oxygenation (ECMO).
Until April 2016, 1067 articles were found, of which 22 were included in our meta-analysis. This showed that the odds of survival with LHR <1.0 and liver herniation on ultrasound were 0.14 (CI 0.10-0.27) and 0.21 (CI 0.13-0.35) respectively. Mean LHR, o/e LHR, absolute TFLV, o/e TFLV, PPLV and liver herniation all predicted survival, however o/e LHR and o/e TFLV performed best in this prediction. When the longest diameter measurement method was used, the o/e TFLV (summary area under curve (AUC) 0.8) was slightly superior to o/e LHR (summary AUC 0.78). This difference disappeared when LHR was measured by the trace method. The most discriminatory threshold for O/E LHR and O/E TFLV was 25%. LHR <1 was predictive of extracorporeal life support (ECLS) use.
O/E LHR, o/e TFLV (thresholds of 25%) and liver herniation are good predictors of mortality in CDH.
Level II Type of study: Systematic review and meta-analysis.
肺发育不全是孤立性先天性膈疝（CDH）死亡的主要原因，在为家长提供咨询时，对其进行预测至关重要。我们试图确定预测CDH新生儿死亡率的产前参数。
在MEDLINE、EMBASE、Cochrane系统评价数据库、PubMed、Scopus和Web of Science中检索肺头比（LHR）、观察到的与预期的LHR（o/e LHR）、胎儿肺总体积（TFLV）、o/e TFLV、预测肺体积百分比（PPLV）和肝脏疝入程度预测CDH胎儿新生儿发病率和死亡率的能力。主要结局是围产期生存，次要结局是体外膜肺氧合（ECMO）的使用。
截至2016年4月，共检索到1067篇文章，其中22篇纳入我们的荟萃分析。结果显示，超声检查时LHR<1.0和肝脏疝入的生存几率分别为0.14（95%CI 0.10-0.27）和0.21（95%CI 0.13-0.35）。平均LHR、o/e LHR、绝对TFLV、o/e TFLV、PPLV和肝脏疝入均能预测生存，但o/e LHR和o/e TFLV在该预测中表现最佳。采用最长径测量法时，o/e TFLV（曲线下面积（AUC）汇总值0.8）略优于o/e LHR（汇总AUC 0.78）。采用轨迹法测量LHR时，这种差异消失。o/e LHR和o/e TFLV最具鉴别力的阈值为25%。LHR<1可预测体外生命支持（ECLS）的使用。
o/e LHR、o/e TFLV（阈值为25%）和肝脏疝入是CDH死亡率的良好预测指标。
II级 研究类型：系统评价和荟萃分析。
