The relationship between three signs of fetal magnetic resonance imaging and severity of congenital diaphragmatic hernia

• Published in: Journal of perinatology 2017-03, Vol.37 (3), p.265-269
• Main Authors: Hattori, T, Hayakawa, M, Ito, M, Sato, Y, Tamakoshi, K, Kanamori, Y, Okuyama, H, Inamura, N, Takahashi, S, Fujino, Y, Taguchi, T, Usui, N
• Format: Article
• Language: English
• Subjects: 692/499; 692/53/2423; Childrens health; Confidence intervals; Diaphragm; Diaphragmatic hernia; Extracorporeal membrane oxygenation; Female; Fetus - diagnostic imaging; Fetuses; Genetic disorders; Gestational Age; Hernia; Hernias; Hernias, Diaphragmatic, Congenital - diagnostic imaging; Hernias, Diaphragmatic, Congenital - mortality; Hospitals; Humans; Infant, Newborn; Intensive care; Investigations; Japan; Liver - diagnostic imaging; Logistic Models; Lung - diagnostic imaging; Lungs; Magnetic Resonance Imaging; Male; Maternal & child health; Medical imaging; Medical prognosis; Medicine; Medicine & Public Health; Methods; Morphology; Neonatal care; Nitric oxide; original-article; Pediatric Surgery; Pediatrics; Physiological aspects; Pregnancy; Prenatal Care; Prenatal Diagnosis - methods; Questionnaires; Resonance; Retrospective Studies; Severity of Illness Index; Stomach - diagnostic imaging; Surgery; Survival; University graduates; Ventilators
• ISSN: 0743-8346; 1476-5543
• DOI: 10.1038/jp.2016.208

Objective: To seek a simple approach for prenatally classifying congenital diaphragmatic hernia (CDH) severity using fetal magnetic resonance imaging (MRI) markers. Study design: A retrospective, multicenter study using questionnaires to investigate fetal MRI findings. We included fetuses prenatally diagnosed with isolated left-sided CDH and delivered after 36 weeks of gestation. We focused on three fetal MRI morphological signs: incomplete pulmonary baseline (IPB), liver up (LU) and retrocardiac stomach (RCS). We also evaluated the fetal MRI score defined as the total number of positive signs; the primary outcome was survival at discharge. Results: In 256 patients (from 56 institutions), IPB, LU and RCS findings correlated with lower survival: odds ratio (95% confidence interval), 0.16 (0.08 to 0.33); 0.24 (0.12 to 0.51); and 0.14 (0.07 to 0.28); respectively. Patients with higher fetal MRI scores had a higher mortality rate. Conclusion: IPB, LU and RCS on fetal MRI are related to CDH severity.