Lung size and liver herniation predict need for extracorporeal membrane oxygenation but not pulmonary hypertension in isolated congenital diaphragmatic hernia: systematic review and meta‐analysis

• Published in: Ultrasound in obstetrics & gynecology 2017-06, Vol.49 (6), p.704-713
• Main Authors: Russo, F. M., Eastwood, M. P., Keijzer, R., Al‐Maary, J., Toelen, J., Van Mieghem, T., Deprest, J. A.
• Format: Article
• Language: English
• Subjects: Age; congenital diaphragmatic hernia; Copyright; Criteria; Diagnostic software; Diagnostic systems; Diaphragms; ECMO; Evidence-based medicine; Extracorporeal Membrane Oxygenation; Female; fetal MRI; fetal ultrasound; Fetuses; Head; Hernia; Hernias; Hernias, Diaphragmatic, Congenital - complications; Hernias, Diaphragmatic, Congenital - diagnostic imaging; Hernias, Diaphragmatic, Congenital - physiopathology; Hernias, Diaphragmatic, Congenital - therapy; Humans; Hypertension; Incidence; Links; Literature reviews; Liver; Liver cancer; Liver Diseases - complications; Liver Diseases - congenital; Lung - pathology; Lungs; Magnetic resonance imaging; Management; Meta-analysis; Occlusion; Oxygenation; Populations; Predictions; Predictive Value of Tests; Pregnancy; Pulmonary hypertension; Quality assessment; Resonance; Respiratory therapy; Risk assessment; Sensitivity; Sensitivity analysis; Severity of Illness Index; Systematic review; Ultrasonography, Prenatal; Ultrasound
• ISSN: 0960-7692; 1469-0705
• DOI: 10.1002/uog.16000

ABSTRACT Objectives To identify antenatal predictors of persistent pulmonary hypertension (PPH) and the need for extracorporeal membrane oxygenation (ECMO) in fetuses with congenital diaphragmatic hernia (CDH). Methods We performed a systematic literature review on antenatal diagnostic tests in fetuses with isolated CDH. The primary outcomes assessed were PPH within 28 days of age and the need for ECMO. Quality of studies was assessed with the QUADAS‐2 tool. Meta‐analysis was performed when at least three studies reported on the same test. Sensitivity analysis was performed according to prenatal management of CDH (tracheal occlusion vs expectant management). Results Thirty‐eight studies met the inclusion criteria. Fifteen reported on the incidence of PPH only, 19 on the need for ECMO only and four reported on both outcomes. The general quality of the studies was moderate; most studies were retrospective (61%) and single‐center series (92%). One study included only fetuses undergoing tracheal occlusion, 22 included only fetuses managed expectantly in utero and 15 included both populations. We could not identify antenatal predictors of PPH. The need for ECMO was predicted by parameters indicative of lung size: lung‐to‐head ratio (LHR) (relative risk (RR) for LHR