Prenatal predictors of mortality in fetuses with congenital diaphragmatic hernia: a systematic review and meta-analysis
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In brief
In brief
Systematic review identifies prenatal ultrasound measurements that predict mortality in fetuses with congenital diaphragmatic hernia. Observed-to-expected lung-to-head ratio, total fetal lung volume, and lung-to-thorax ratio showed comparable predictive accuracy for neonatal outcomes, with diagnostic odds ratios exceeding 10 when below critical thresholds.
Written by the GCMD Library team from the article.
Abstract
Purpose
This study aimed to evaluate prenatal predictors of mortality in fetuses with congenital diaphragmatic hernia (CDH).
Methods
A systematic literature search was performed to identify relevant observational studies that evaluated the ability of lung-to-head ratio (LHR), observed-to-expected LHR (o/e-LHR), observed-to-expected total fetal lung volume (o/e-TFLV), lung-to-thorax transverse area ratio (L/T ratio), intrathoracic herniation of the liver and the stomach, and side of diaphragmatic hernia, using a threshold for the prediction of mortality in fetuses with CDH. Study quality was assessed using the QUADAS-2 tool. Hierarchical summary receiver operating characteristic curves were constructed.
Results
A total of 50 articles were included in this meta-analysis. The QUADAS-2 tool identified a high risk of bias in more than one domain scored in all parameters. Among those parameters, the diagnostic odds ratio of mortality with o/e-LHR < 25%, o/e-TFLV < 25%, and L/T ratio < 0.08 were 11.98 [95% confidence interval (CI) 4.65–30.89], 11.14 (95% CI 5.19–23.89), and 10.28 (95% CI 3.38–31.31), respectively. The predictive values for mortality were similar between the presence of liver herniation and retrocardiac fetal stomach position.
Conclusions
This systematic review suggests that o/e-LHR, o/e-TFLV, and L/T ratio are equally good predictors of neonatal mortality in fetuses with isolated CDH.