Related Experiment Video
Updated: May 15, 2026
Continuous Telemetric In Utero Tracheal Pressure Measurements in Fetal Lambs
Published on: December 22, 2023
Lung to head ratio in infants with congenital diaphragmatic hernia does not predict long term pulmonary hypertension
Alejandro V Garcia1, Abbey L Fingeret, Arul S Thirumoorthi
1Department of Surgery, Division of Pediatric Surgery, Morgan Stanley Children's Hospital of New York-Presbyterian, New York, NY 10032, USA. alg2025@columbia.edu
Insights
Prenatal lung-to-head ratio (LHR) predicts pulmonary hypertension at one month in infants with congenital diaphragmatic hernia (CDH). However, LHR does not predict long-term pulmonary hypertension in CDH infants.
Area of Science:
- Pediatric Surgery
- Neonatology
- Pulmonology
Background:
- Congenital diaphragmatic hernia (CDH) is a serious condition requiring antenatal evaluation.
- Lung-to-head ratio (LHR) is a key metric used for assessing CDH severity before birth.
Purpose of the Study:
- To determine if prenatal Lung-to-head ratio (LHR) can predict the development of pulmonary hypertension in infants with CDH.
- To investigate the association between LHR and both acute and chronic pulmonary hypertension post-CDH repair.
Main Methods:
- Retrospective review of echocardiograms for 106 infants with CDH from December 2001 to March 2011.
- Assessment of pulmonary hypertension (PAH) at 1 month, 3 months, and long-term follow-up post-CDH repair.
- Statistical analysis including bivariate and multivariate methods to correlate LHR with PAH, ECMO use, and mortality.
Main Results:
- A prenatal LHR was obtained in 106 infants with CDH (median LHR 1.25).
- Pulmonary hypertension was present in 16% of infants at long-term follow-up.
- LHR significantly predicted pulmonary hypertension at one month (p=0.0001) and was associated with ECMO use (p=0.01) and mortality (p=0.001), but not with long-term PAH (p=0.54).
Conclusions:
- Prenatal LHR is a valuable predictor of early pulmonary hypertension in CDH infants.
- LHR's predictive ability for pulmonary hypertension diminishes over time, suggesting pulmonary vascular remodeling.
- The findings highlight the transient predictive value of LHR for pulmonary hypertension in CDH.
Purpose:
Lung-to-head ratio (LHR) has been used for antenatal evaluation of infants with congenital diaphragmatic hernia (CDH). We hypothesized that LHR was predictive of acute and chronic pulmonary hypertension in infants with CDH.
Methods:
Echocardiograms on all inborn infants with CDH (December 2001-March 2011) were reviewed. Echocardiograms at 1 and 3 months post-repair and most recent follow-up were assessed for presence of pulmonary hypertension (PAH). LHR, gestational age, birth weight, extracorporeal membrane oxygenation (ECMO), and death rate were obtained. Bivariate and multivariate analyses were performed.
Results:
106 infants with CDH had LHR obtained at median 28 weeks gestation (median LHR=1.25 [range 0.4-5.3]). Median follow-up was 26.6 months (range 4.6-97.5). The long-term incidence of pulmonary hypertension was 16%. LHR was significantly associated with pulmonary hypertension at one month (p=0.0001) but not at 3 months (p=0.22) or long-term (p=0.54). LHR was predictive of ECMO use (p=0.01) and death (p=0.001).
Conclusions:
The overall incidence of PAH in infants with CDH decreases over time. Prenatal LHR predicts PAH at one month but not long-term in infants with CDH. The ability for LHR to predict PAH at one month but not long term may suggest remodeling of the pulmonary vasculature over time.
