Weis Meike, Burhany Sosan, Perez Ortiz Alba, Nowak Oliver, Hetjens Svetlana, Zahn Katrin, Schoenberg Stefan, Schaible Thomas, Rafat Neysan
Department of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany.
Department of Neonatology, University Children's Hospital Mannheim, University of Heidelberg, Mannheim, Germany.
Front Pediatr. 2021 Dec 23;9:740941. doi: 10.3389/fped.2021.740941. eCollection 2021.
Valid postnatal prediction parameters for neonates with congenital diaphragmatic hernia (CDH) are lacking, but recently, the chest radiographic thoracic area (CRTA) was proposed to predict survival with high sensitivity. Here, we evaluated whether the CRTA correlated with morbidity and mortality in neonates with CDH and was able to predict these with higher sensitivity and specificity than prenatal observed-to-expected (O/E) lung-to-head ratio (LHR). In this retrospective cohort study, all neonates with CDH admitted to our institution between 2013 and 2019 were included. The CRTA was measured using the software Horos (V. 3.3.5) and compared with O/E LHR diagnosed by fetal ultrasonography in relation to outcome parameters including survival, extracorporeal membrane oxygenation (ECMO) support, and chronic lung disease (CLD). In this study 255 neonates were included with a survival to discharge of 84%, ECMO support in 46%, and 56% developing a CLD. Multiple regression analysis demonstrated that the CRTA correlates significantly with survival ( = 0.001), ECMO support ( < 0.0001), and development of CLD ( = 0.0193). The CRTA displayed a higher prognostic validity for survival [area under the curve (AUC) = 0.822], ECMO support (AUC = 0.802), and developing a CLD (AUC = 0.855) compared with the O/E LHR. Our data suggest that the postnatal CRTA might be a better prognostic parameter for morbidity and mortality than the prenatal O/E LHR.
目前尚缺乏用于先天性膈疝（CDH）新生儿的有效产后预测参数，但最近有人提出胸部X线胸廓面积（CRTA）可用于高灵敏度地预测生存情况。在此，我们评估了CRTA是否与CDH新生儿的发病率和死亡率相关，以及其预测这些情况的灵敏度和特异性是否高于产前观察到的预期（O/E）肺头比（LHR）。在这项回顾性队列研究中，纳入了2013年至2019年间我院收治的所有CDH新生儿。使用Horos软件（版本3.3.5）测量CRTA，并将其与通过胎儿超声诊断的O/E LHR进行比较，以分析包括生存、体外膜肺氧合（ECMO）支持和慢性肺病（CLD）等结局参数。本研究纳入了255例新生儿，出院生存率为84%，46%接受了ECMO支持，56%发生了CLD。多元回归分析表明，CRTA与生存（P = 0.001）、ECMO支持（P < 0.0001）和CLD的发生（P = 0.0193）显著相关。与O/E LHR相比，CRTA在生存[曲线下面积（AUC）= 0.822]、ECMO支持（AUC = 0.802）和发生CLD（AUC = 0.855）方面显示出更高的预后有效性。我们的数据表明，产后CRTA可能是比产前O/E LHR更好的发病率和死亡率预后参数。
