Prenatal magnetic resonance imaging parameters predict mortality and the need for extracorporeal membrane oxygenation in isolated congenital diaphragmatic hernia

Abstract

Objective To determine the association between MRI findings and mortality or need for extracorporeal membrane oxygenation (ECMO) in cases of isolated congenital diaphragmatic hernia (CDH). Study Design Retrospective cohort study of all fetuses with isolated CDH followed in between January 2004 and July 2011. The following MRI parameters were evaluated between 20 and 32 weeks: i) the observed/expected total fetal lung volume (o/e-TLV); ii) the predicted pulmonary volume (PPV) calculated by the lung/thoracic volume ratio; iii) the percentage of liver herniated into fetal thorax (%LH), calculated by the herniated liver/total liver volume ratio; iv) the liver/thoracic volume ratio (LiTh). The predictability of MRI parameters for mortality and need for ECMO was evaluated by univariate, multiple regression, factor analysis and ROC curves. Results 71 fetuses with isolated (61 left and 10 right) CDH were evaluated. Overall mortality was 17/71 (23.9%). One fetus died in utero, and one died a few hours after birth. ECMO was indicated in 26/69 (37.7%) newborns with survival rate of 50.0%. The side of the diaphragmatic defect was not associated with mortality (p=0.55) or the need for ECMO (p=0.49). Good correlation was observed between o/e-TLV and PPV (r=0.47; p0.05). All four MRI parameters were statistically associated with mortality or need for ECMO (Table 1). The best combination to predict mortality using MRI − o/e-TLV+%LH with probability of death=exp(−0.35+(0.87x(1−o/eTLV))+(0.01x%LH))/(1+(exp(−0.35+(0.87x(1−o/eTLV))+(0.01x%LH))). ECMO was used in cases with higher probability of death (>60%) when compared to those that did not need ECMO (probability of death less than 40%; p<0.01). Full-size table Table options Conclusion Mortality and need for ECMO in neonates with isolated CDH can be accurately predicted during prenatal life using MRI through the combination of fetal lung volume measurements and the amount of liver herniated into the fetal thorax.