BIOMAT Database Logo BIOMAT Database Logo

Prenatal prediction of pulmonary arterial hypertension in congenital diaphragmatic hernia. 2015

E Spaggiari, and J J Stirnemann, and P Sonigo, and N Khen-Dunlop, and L De Saint Blanquat, and Y Ville
Department of Obstetrics and Maternal-Fetal Medicine, Necker-Enfants Malades Hospital, AP-HP, Paris, France; University Paris Descartes, Sorbonne Paris-Cité, Paris, France.

OBJECTIVE To evaluate the role of prenatal prognostic markers obtained routinely by ultrasound examination and magnetic resonance imaging (MRI) in the prediction of development of postnatal pulmonary arterial hypertension (PAH) in isolated congenital diaphragmatic hernia (CDH). METHODS One hundred and ten cases of isolated CDH were referred to our fetal medicine unit between January 2004 and April 2013. Mortality and morbidity rates were reviewed for those presenting with postnatal PAH. The following prenatal markers were evaluated as potential predictive factors of PAH: liver position, side of the CDH defect, lung area to head circumference ratio (LHR) and observed/expected LHR (o/e-LHR), which were measured by ultrasound, and observed/expected total fetal lung volume (o/e-TFLV), which was measured by MRI. Univariable logistic regression was used to assess associations. RESULTS PAH was significantly associated with perinatal mortality and morbidity (P < 0.001). The occurrence of PAH decreased significantly with an increasing LHR, o/e-LHR and o/e-TFLV and was significantly increased for cases with an intrathoracic liver, but not for those with right-sided defects. Univariable regression revealed that o/e-TFLV (odds ratio (OR), 0.9 (95% CI, 0.86-0.95); P < 0.05 for percentage unit change in o/e), LHR (OR, 0.19 (95% CI, 0.09-0.40); P < 0.05 for unit change), o/e-LHR (OR, 0.95 (95% CI, 0.93-0.98); P < 0.05 for percentage unit change in o/e) and liver position (OR, 2.82 (95% CI, 1.13-7.00); P < 0.05 for intrathoracic liver) were significant predictors of subsequent PAH. No differences were found after adjusting for gestational age at delivery. The areas under the receiver-operating characteristics curve were 0.80 and 0.75 for o/e-TFLV and o/e-LHR, respectively. CONCLUSIONS In cases of CDH, PAH is associated with high rates of mortality and morbidity. Routinely obtained prenatal markers, usually used for the assessment of pulmonary hypoplasia, are also relevant for the postnatal prediction of PAH.

UI MeSH Term Description Entries
D006976 Hypertension, Pulmonary Increased VASCULAR RESISTANCE in the PULMONARY CIRCULATION, usually secondary to HEART DISEASES or LUNG DISEASES. Pulmonary Hypertension
D007231 Infant, Newborn An infant during the first 28 days after birth. Neonate,Newborns,Infants, Newborn,Neonates,Newborn,Newborn Infant,Newborn Infants
D008099 Liver A large lobed glandular organ in the abdomen of vertebrates that is responsible for detoxification, metabolism, synthesis and storage of various substances. Livers
D008168 Lung Either of the pair of organs occupying the cavity of the thorax that effect the aeration of the blood. Lungs
D008176 Lung Volume Measurements Measurement of the amount of air that the lungs may contain at various points in the respiratory cycle. Lung Capacities,Lung Volumes,Capacity, Lung,Lung Capacity,Lung Volume,Lung Volume Measurement,Measurement, Lung Volume,Volume, Lung
D011237 Predictive Value of Tests In screening and diagnostic tests, the probability that a person with a positive test is a true positive (i.e., has the disease), is referred to as the predictive value of a positive test; whereas, the predictive value of a negative test is the probability that the person with a negative test does not have the disease. Predictive value is related to the sensitivity and specificity of the test. Negative Predictive Value,Positive Predictive Value,Predictive Value Of Test,Predictive Values Of Tests,Negative Predictive Values,Positive Predictive Values,Predictive Value, Negative,Predictive Value, Positive
D011247 Pregnancy The status during which female mammals carry their developing young (EMBRYOS or FETUSES) in utero before birth, beginning from FERTILIZATION to BIRTH. Gestation,Pregnancies
D011379 Prognosis A prediction of the probable outcome of a disease based on a individual's condition and the usual course of the disease as seen in similar situations. Prognostic Factor,Prognostic Factors,Factor, Prognostic,Factors, Prognostic,Prognoses
D005260 Female Females
D005865 Gestational Age The age of the conceptus, beginning from the time of FERTILIZATION. In clinical obstetrics, the gestational age is often estimated from the onset of the last MENSTRUATION which is about 2 weeks before OVULATION and fertilization. It is also estimated to begin from fertilization, estrus, coitus, or artificial insemination. Embryologic Age,Fetal Maturity, Chronologic,Chronologic Fetal Maturity,Fetal Age,Maturity, Chronologic Fetal,Age, Embryologic,Age, Fetal,Age, Gestational,Ages, Embryologic,Ages, Fetal,Ages, Gestational,Embryologic Ages,Fetal Ages,Gestational Ages

Related Publications

E Spaggiari, and J J Stirnemann, and P Sonigo, and N Khen-Dunlop, and L De Saint Blanquat, and Y Ville
Pulmonary hypertension in congenital diaphragmatic hernia.
May 2007, Seminars in pediatric surgery,
E Spaggiari, and J J Stirnemann, and P Sonigo, and N Khen-Dunlop, and L De Saint Blanquat, and Y Ville
Congenital diaphragmatic hernia-associated pulmonary hypertension.
February 2020, Seminars in perinatology,
E Spaggiari, and J J Stirnemann, and P Sonigo, and N Khen-Dunlop, and L De Saint Blanquat, and Y Ville
Congenital diaphragmatic hernia-associated pulmonary hypertension.
June 2017, Seminars in pediatric surgery,
E Spaggiari, and J J Stirnemann, and P Sonigo, and N Khen-Dunlop, and L De Saint Blanquat, and Y Ville
Prenatal pulmonary hypertension index: novel prenatal predictor of severe postnatal pulmonary artery hypertension in antenatally diagnosed congenital diaphragmatic hernia.
April 2010, Journal of pediatric surgery,
E Spaggiari, and J J Stirnemann, and P Sonigo, and N Khen-Dunlop, and L De Saint Blanquat, and Y Ville
Pulmonary hypertension associated with congenital diaphragmatic hernia.
May 2009, Cardiology in the young,
E Spaggiari, and J J Stirnemann, and P Sonigo, and N Khen-Dunlop, and L De Saint Blanquat, and Y Ville
Effect of prenatal diaphragmatic hernia on pulmonary arterial morphology.
January 2023, Anatomical record (Hoboken, N.J. : 2007),
E Spaggiari, and J J Stirnemann, and P Sonigo, and N Khen-Dunlop, and L De Saint Blanquat, and Y Ville
Pulmonary hypertension in congenital diaphragmatic hernia: Antenatal prediction and impact on neonatal mortality.
September 2022, Prenatal diagnosis,
E Spaggiari, and J J Stirnemann, and P Sonigo, and N Khen-Dunlop, and L De Saint Blanquat, and Y Ville
Congenital Diaphragmatic Hernia: Pulmonary Hypertension and Pulmonary Vascular Disease.
March 2024, Clinics in perinatology,
E Spaggiari, and J J Stirnemann, and P Sonigo, and N Khen-Dunlop, and L De Saint Blanquat, and Y Ville
Diagnosis & management of pulmonary hypertension in congenital diaphragmatic hernia.
August 2022, Seminars in fetal & neonatal medicine,
E Spaggiari, and J J Stirnemann, and P Sonigo, and N Khen-Dunlop, and L De Saint Blanquat, and Y Ville
Congenital diaphragmatic hernia: arterial structural changes and persistent pulmonary hypertension after surgical repair.
September 1985, The Journal of pediatrics,
Copied contents to your clipboard!