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Association between changes in the lung-to-head ratio and postnatal survival in fetuses with congenital diaphragmatic
Yiqing Yu1, Qingwei Qi1, Xiya Zhou1
1Department of Obstetrics and Gynecology, National Clinical Research Center for Women's Health and Obstetric and Gynecologic Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
Introduction:
To evaluate the association between longitudinal changes in Observed-to-Expected Lung-to-Head Ratio (O/E LHR) measured by ultrasound and postnatal survival in fetuses with Congenital Diaphragmatic Hernia (CDH).
Methods:
A total of 74 pregnant women carrying fetuses with CDH were retrospectively analyzed. The change in O/E LHR (ΔO/E LHR) was assessed as a continuous variable using univariate and multivariate logistic regression analyses. Hernia lateralization and liver herniation were combined into a single categorical variable to account for their clinical and statistical correlation. Receiver Operating Characteristic (ROC) analysis was performed to evaluate the discriminative ability of ΔO/E LHR for survival.
Results:
The majority of patients (86% and 74% according to the first and last ultrasound examinations, respectively) in this cohort had mild CDH, with an overall survival rate of 73.0%. ΔO/E LHR differed significantly between survivors and non-survivors (13.32±22.09 vs. -13.93±17.59, p < 0.001). In multivariate analysis, ΔO/E LHR (OR = 1.089, 95% CI 1.024-1.158; p = 0.007), gestational age at diagnosis (OR = 1.462, 95% CI 1.041-2.053; p = 0.029), and the combined variable of hernia lateralization and liver herniation (p = 0.011) were associated with survival. ROC analysis of ΔO/E LHR yielded an AUC of 0.836 (95% CI 0.725-0.948).
Conclusion:
In this single-center cohort of fetuses with predominantly mild CDH, ΔO/E LHR was associated with postnatal survival and showed good discriminative performance. Gestational age at diagnosis and the combined variable of hernia lateralization and liver herniation were also associated with outcomes. However, estimates for individual anatomical subgroups were imprecise because of the limited number of cases and should not be used for individual risk prediction. These findings suggest that longitudinal assessment of O/E LHR may be more informative than a single measurement in this specific population. Further validation in larger cohorts is warranted.
