Kontopoulos Eftichia, Bulman Mikaela, Gordienko Irina, Rodriguez Maria Jose, Gallardo Manuel, Copado Yazmin, Acevedo Sandra, Quintero Luis, Quintero Ruben A
The USFetus Research Consortium, Miami, FL, USA.
Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Florida International University, Miami, FL, USA.
J Matern Fetal Neonatal Med. 2023 Dec;36(2):2242555. doi: 10.1080/14767058.2023.2242555.
We have previously described gestational-age-independent sonographic indices to assess fetal lung size in the right and left lungs: The Quantitative Lung Index for the right lung (QLI-R) and for the left lung (QLI-L), respectively. The purpose of this study was to evaluate the clinical cutoff point of the QLI-R to predict pulmonary hypoplasia and neonatal death.
Retrospective assessment of the QLI-R in patients with left-sided congenital diaphragmatic hernia (CDH-L) and other fetal conditions at risk for fetal pulmonary hypoplasia. Cross-section and longitudinal assessment of the behavior of the QLI-R in untreated and treated patients. ROC curve analysis to determine the optimal cutoff point of the QLI-R in predicting neonatal death.
One hundred eighteen patients with CDH-L and other fetal conditions at risk for pulmonary hypoplasia had QLI-R measurements done. Seventeen patients were excluded for various reasons. Eleven patients with conditions other than CDH-L but at risk for pulmonary hypoplasia were used for intraclass coefficient measurements of the QLI-R. Ninety patients had CDH-L, of which 78 did not undergo antenatal intervention and in which the cutoff point for pulmonary hypoplasia and neonatal demise was assessed. Stent tracheal occlusion was performed in the remaining 12 patients with CDH-L, in which the behavior of the QLI after surgery was assessed. Analysis of the ICC showed an overall intra-rater reliability of 0.985 (Cronbach's Alpha-based). There was no correlation between gestational age and QLI-R (-0.73, Pearson correlation, = .72). Twenty-six of the 78 patients (33%) with CDH-L managed expectantly had a neonatal demise. A QLI-R equal to or less than 0.45 was significantly predictive of neonatal demise (area under the curve 0.64, = .046, sensitivity 77%). Nine of the 12 patients (75%) that underwent tracheal occlusion had neonatal survival. Of these, 10 had serial assessments of the QLI-R after surgery. An increase in the QLI-R of 0.11 was associated with a tendency for neonatal survival ( = .056).
Our study confirms that the QLI-R is a gestational-age-independent measurement of fetal lung size, with a high degree of reproducibility. In a population of expectantly managed CDH-L patients, a cutoff value of the QLI-R of 0.45 or lower is predictive of neonatal death from pulmonary hypoplasia. The QLI-R can be used to monitor fetal lung growth after tracheal occlusion, and an increase in the QLI-R is suggestive of neonatal survival. Further prospective studies are needed to confirm these findings and to explore the use of the QLI in other populations at risk for pulmonary hypoplasia and consequent neonatal demise.
我们之前已经描述了与胎龄无关的超声指标，用于评估胎儿左右肺的大小：分别为右肺定量肺指数（QLI-R）和左肺定量肺指数（QLI-L）。本研究的目的是评估QLI-R预测肺发育不全和新生儿死亡的临床临界值。
回顾性评估左侧先天性膈疝（CDH-L）患者及其他有胎儿肺发育不全风险的胎儿状况的QLI-R。对未治疗和已治疗患者的QLI-R行为进行横断面和纵向评估。采用ROC曲线分析确定QLI-R预测新生儿死亡的最佳临界值。
118例患有CDH-L及其他有肺发育不全风险的胎儿状况的患者进行了QLI-R测量。17例患者因各种原因被排除。11例患有除CDH-L外但有肺发育不全风险的疾病的患者用于QLI-R的组内系数测量。90例患者患有CDH-L，其中78例未接受产前干预，并对其肺发育不全和新生儿死亡的临界值进行了评估。其余12例CDH-L患者进行了气管支架置入术，并评估了术后QLI的变化情况。ICC分析显示总体评分者内信度为0.985（基于Cronbach's Alpha）。胎龄与QLI-R之间无相关性（-0.73，Pearson相关性，P = 0.72）。78例预期治疗的CDH-L患者中有26例（33%）新生儿死亡。QLI-R等于或小于0.45可显著预测新生儿死亡（曲线下面积0.64，P = 0.046，敏感性77%）。12例接受气管闭塞术的患者中有9例（75%）新生儿存活。其中，10例术后进行了QLI-R的系列评估。QLI-R增加0.11与新生儿存活趋势相关（P = 0.056）。
我们的研究证实QLI-R是一种与胎龄无关的胎儿肺大小测量方法，具有高度的可重复性。在预期治疗的CDH-L患者群体中，QLI-R临界值为0.45或更低可预测因肺发育不全导致的新生儿死亡。QLI-R可用于监测气管闭塞术后胎儿肺的生长情况，QLI-R增加提示新生儿存活。需要进一步的前瞻性研究来证实这些发现，并探索QLI在其他有肺发育不全风险及随之而来的新生儿死亡风险的人群中的应用。
