AI Article Synopsis
- This study examines lung size and intrapulmonary artery (IPa) blood flow in fetuses with congenital diaphragmatic hernia (CDH) to predict neonatal survival.
- Methods included tracking observed/expected lung-to-head ratio (O/E-LHR) and IPa-Doppler metrics in a group of fetuses, analyzing changes over time and their correlation with survival odds.
- Results showed consistent O/E-LHR but worsening IPa indices, suggesting that while lung size is stable, impaired blood flow in CDH fetuses can help gauge survival likelihood during pregnancy.
Article Abstract
Objectives: The objectives of the study are to evaluate longitudinal changes in lung size and intrapulmonary-artery (IPa) Doppler in fetuses with congenital diaphragmatic hernia (CDH) and assess their contribution in predicting neonatal survival.
Methods: The observed/expected lung-to-head ratio (O/E-LHR) and IPa-pulsatility index (PI) and peak early diastolic reversed flow (PEDRF) were evaluated in a cohort of left-sided CDH fetuses managed expectantly during pregnancy. Longitudinal changes were analyzed by multilevel analysis, and their value to predict survival using the multiple logistic regression and decision-tree analysis was assessed.
Results: A total of 232 scans were performed on 69 CDH fetuses. The O/E-LHR values remained unchanged during fetal monitoring, whereas IPa-PI and PEDRF showed a progressive increase throughout follow-up, becoming abnormal on average at 30 weeks of gestation. Absent/reversed end-diastolic velocity (EDV) in the IPa was observed in 20.3%. O/E-LHR and IPa Doppler indices were significantly associated with probability of survival (O/E-LHR ≥ 26%, odds ratio [OR] 19.0; IPa-PI <+2.0 z score, OR 3.0; and positive EDV, OR 7.4). All cases with IPa-reversed EDV died after birth.
Conclusion: While lung size remains stable during pregnancy, CDH fetuses show progressive deterioration in intrapulmonary blood flow. IPa Doppler evaluation may aid in predicting survival of CDH fetuses managed expectantly during pregnancy.
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| http://dx.doi.org/10.1002/pd.5401 | DOI Listing |
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