Fetal Lung Volume Appears to Predict Respiratory Morbidity in Congenital Diaphragmatic Hernia

Area of Science:

• Pediatric Surgery
• Neonatology
• Fetal Medicine

Background:

• Congenital diaphragmatic hernia (CDH) often leads to pulmonary hypoplasia and significant respiratory morbidity in newborns.
• Accurate prediction of respiratory outcomes in infants with CDH is crucial for optimal management and parental counseling.

Purpose of the Study:

• To determine if fetal lung volume, assessed via the observed-to-expected fetal lung volume ratio (o/e FLV) using antenatal MRI, correlates with respiratory morbidity in the first two years of life for infants with left-sided CDH.
• To identify a predictive threshold for o/e FLV associated with a favorable respiratory outcome.

Main Methods:

• Retrospective analysis of 47 infants diagnosed with left-sided CDH.
• Measurement of o/e FLV using antenatal magnetic resonance imaging (MRI).
• Assessment of respiratory morbidity defined by treatment with inhaled corticosteroids (>3 months) or hospitalization for acute respiratory disease.

Main Results:

• The median o/e FLV was 39% (IQR, 33-49%).
• A threshold of o/e FLV ≥ 44% was identified as the most effective predictor of a favorable outcome (80% of cases), with a positive predictive value of 80% and specificity of 79%.
• Infants with o/e FLV ≥ 44% had significantly reduced rates of respiratory morbidity.

Conclusions:

• Fetal lung volume measurement using antenatal MRI, specifically the o/e FLV ratio, is a valuable tool for predicting respiratory risk in infants with CDH.
• An o/e FLV ≥ 44% may help identify infants with a lower likelihood of significant respiratory morbidity, aiding in personalized follow-up and management decisions.