Standardization of Sonographic Lung-to-Head Ratio Measurements in Isolated Congenital Diaphragmatic Hernia
Impact on the Reproducibility and Efficacy to Predict Outcomes
Ingrid Schwach Werneck Britto MD,PhD
Texas Children's Fetal Center, Houston, Texas USA
Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas USA
Search for more papers by this authorNicolas Sananes MD
Texas Children's Fetal Center, Houston, Texas USA
Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas USA
Search for more papers by this authorOluyinka O. Olutoye MD,PhD
Texas Children's Fetal Center, Houston, Texas USA
Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas USA
Search for more papers by this authorDarrell L. Cass MD
Texas Children's Fetal Center, Houston, Texas USA
Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas USA
Search for more papers by this authorHaleh Sangi-Haghpeykar PhD
Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas USA
Search for more papers by this authorTimothy C. Lee MD
Texas Children's Fetal Center, Houston, Texas USA
Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas USA
Search for more papers by this authorChristopher I. Cassady MD
Texas Children's Fetal Center, Houston, Texas USA
Department of Radiology, Baylor College of Medicine, Houston, Texas USA
Search for more papers by this authorAmy Mehollin-Ray MD
Texas Children's Fetal Center, Houston, Texas USA
Department of Radiology, Baylor College of Medicine, Houston, Texas USA
Search for more papers by this authorStephen Welty MD
Department of Radiology, Baylor College of Medicine, Houston, Texas USA
Department of Pediatrics, Section of Neonatology, Baylor College of Medicine, Houston, Texas USA
Search for more papers by this authorCaraciolo Fernandes MD
Texas Children's Fetal Center, Houston, Texas USA
Department of Pediatrics, Section of Neonatology, Baylor College of Medicine, Houston, Texas USA
Search for more papers by this authorMichael A. Belfort MD,PhD
Texas Children's Fetal Center, Houston, Texas USA
Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas USA
Search for more papers by this authorWesley Lee MD
Texas Children's Fetal Center, Houston, Texas USA
Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas USA
Search for more papers by this authorCorresponding Author
Rodrigo Ruano MD,PhD
Texas Children's Fetal Center, Houston, Texas USA
Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas USA
Address correspondence to Rodrigo Ruano, MD, PhD, Pavilion for Women, Texas Children's Fetal Center, 6651 Main St, Suite F1020, Houston, TX 77030 USA.Search for more papers by this authorIngrid Schwach Werneck Britto MD,PhD
Texas Children's Fetal Center, Houston, Texas USA
Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas USA
Search for more papers by this authorNicolas Sananes MD
Texas Children's Fetal Center, Houston, Texas USA
Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas USA
Search for more papers by this authorOluyinka O. Olutoye MD,PhD
Texas Children's Fetal Center, Houston, Texas USA
Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas USA
Search for more papers by this authorDarrell L. Cass MD
Texas Children's Fetal Center, Houston, Texas USA
Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas USA
Search for more papers by this authorHaleh Sangi-Haghpeykar PhD
Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas USA
Search for more papers by this authorTimothy C. Lee MD
Texas Children's Fetal Center, Houston, Texas USA
Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas USA
Search for more papers by this authorChristopher I. Cassady MD
Texas Children's Fetal Center, Houston, Texas USA
Department of Radiology, Baylor College of Medicine, Houston, Texas USA
Search for more papers by this authorAmy Mehollin-Ray MD
Texas Children's Fetal Center, Houston, Texas USA
Department of Radiology, Baylor College of Medicine, Houston, Texas USA
Search for more papers by this authorStephen Welty MD
Department of Radiology, Baylor College of Medicine, Houston, Texas USA
Department of Pediatrics, Section of Neonatology, Baylor College of Medicine, Houston, Texas USA
Search for more papers by this authorCaraciolo Fernandes MD
Texas Children's Fetal Center, Houston, Texas USA
Department of Pediatrics, Section of Neonatology, Baylor College of Medicine, Houston, Texas USA
Search for more papers by this authorMichael A. Belfort MD,PhD
Texas Children's Fetal Center, Houston, Texas USA
Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas USA
Search for more papers by this authorWesley Lee MD
Texas Children's Fetal Center, Houston, Texas USA
Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas USA
Search for more papers by this authorCorresponding Author
Rodrigo Ruano MD,PhD
Texas Children's Fetal Center, Houston, Texas USA
Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas USA
Address correspondence to Rodrigo Ruano, MD, PhD, Pavilion for Women, Texas Children's Fetal Center, 6651 Main St, Suite F1020, Houston, TX 77030 USA.Search for more papers by this authorAbstract
Objectives
The purpose of this study was to evaluate the impact of standardization of the lung-to-head ratio measurements in isolated congenital diaphragmatic hernia on prediction of neonatal outcomes and reproducibility.
Methods
We conducted a retrospective cohort study of 77 cases of isolated congenital diaphragmatic hernia managed in a single center between 2004 and 2012. We compared lung-to-head ratio measurements that were performed prospectively in our institution without standardization to standardized measurements performed according to a defined protocol.
Results
The standardized lung-to-head ratio measurements were statistically more accurate than the nonstandardized measurements for predicting neonatal mortality (area under the receiver operating characteristic curve, 0.85 versus 0.732; P = .003). After standardization, there were no statistical differences in accuracy between measurements regardless of whether we considered observed-to-expected values (P > .05). Standardization of the lung-to-head ratio did not improve prediction of the need for extracorporeal membrane oxygenation (P> .05). Both intraoperator and interoperator reproducibility were good for the standardized lung-to-head ratio (intraclass correlation coefficient, 0.98 [95% confidence interval, 0.97–0.99]; bias, 0.02 [limits of agreement, −0.11 to +0.15], respectively).
Conclusions
Standardization of lung-to-head ratio measurements improves prediction of neonatal outcomes. Further studies are needed to confirm these results and to assess the utility of standardization of other prognostic parameters.
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