预测产前诊断左侧先天性膈疝患者出院前的新生儿死亡率。

IF 6.1 1区 医学 Q1 ACOUSTICS Ultrasound in Obstetrics & Gynecology Pub Date : 2024-10-24 DOI:10.1002/uog.29121
S Shinar, A Otvodenko, D Kajal, P P L Chiu, S Lee, P S Shah, T Van Mieghem, Y Kunpalin, A-M Guerguerian, G Ryan, N Abbasi
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引用次数: 0

摘要

目的评估标准化产前成像参数和新生儿即时变量与孤立性左侧先天性膈疝(LCDH)婴儿出院前死亡率的关系,并比较基于超声和磁共振成像(MRI)的严重程度分级在预测新生儿死亡率方面的性能:这是一项回顾性研究,研究对象是2008年至2020年间转诊至一家三级医疗中心的产前诊断为孤立性LCDH的婴儿。排除了右侧或双侧先天性膈疝、其他主要结构异常或已知遗传病的胎儿,以及接受胎儿干预或拒绝产后干预的病例。对超声和核磁共振图像进行了回顾性分析。结合产前和新生儿期因素进行单变量和多变量分析,分析出院前新生儿死亡率的相关性,并生成预测计算器。比较了超声和磁共振成像在预测新生儿死亡率方面的性能:结果:在253例患有胎儿CDH的孕妇中,104例符合纳入标准,其中77例(74%)新生儿存活至出院。75名胎儿同时接受了产前超声和磁共振成像检查。在多变量分析中,观察/预期(o/e)肺头比和o/e胎儿肺总量与新生儿死亡独立相关(调整后的几率分别为0.89(95% CI,0.83-0.95)和0.90(95% CI,0.84-0.97)),而肝脏位置与新生儿死亡无关。同时使用超声波和核磁共振成像(受体运算特征曲线下面积(AUC)为 0.85(95% CI,0.76-0.93))与单独使用超声波(AUC,0.81(95% CI,0.72-0.90);P = 0.19)在预测性能上没有明显差异。与超声和磁共振成像联合模型相比,增加新生儿参数(出生时胎龄和小于胎龄)并没有提高模型性能(AUC,0.87(95% CI,0.80-0.95))(P = 0.22)。超声和核磁共振成像的严重程度评估之间的一致性较差(Cohen's κ,0.19)。大多数差异出现在超声检查认为不严重而核磁共振检查认为严重的病例中,而基于核磁共振检查的预后结果更为一致:结论:对于产前诊断为孤立性LCDH的胎儿,使用标准化超声和磁共振成像测量方法预测死亡率的效果相当好。结论:对于产前诊断为孤立性 LCDH 的胎儿,使用标准化超声和核磁共振成像测量结果预测死亡率的效果相当不错。对于超声分类为非重度的病例,建议使用核磁共振成像,因为它可以提供更准确的预后,并有助于确定胎儿是否适合接受干预。© 2024 作者姓名妇产科超声》由 John Wiley & Sons Ltd 代表国际妇产科超声学会出版。
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Predicting neonatal mortality prior to discharge from hospital in prenatally diagnosed left congenital diaphragmatic hernia.

Objectives: To evaluate the association of standardized prenatal imaging parameters and immediate neonatal variables with mortality prior to discharge in infants with isolated left congenital diaphragmatic hernia (LCDH), and to compare the performance of ultrasound- and magnetic resonance imaging (MRI)-based severity grading for the prediction of neonatal mortality.

Methods: This was a retrospective study of infants with prenatally diagnosed isolated LCDH referred to a single tertiary center between 2008 and 2020. Fetuses with right or bilateral congenital diaphragmatic hernia, additional major structural anomaly or known genetic condition, as well as cases that underwent fetal intervention or declined postnatal intervention, were excluded. Ultrasound and MRI images were reviewed retrospectively. Univariable and multivariable analyses were performed, incorporating prenatal and immediate neonatal factors to analyze the association with neonatal mortality prior to discharge, and a prediction calculator was generated. The performance of ultrasound and that of MRI for the prediction of neonatal mortality were compared.

Results: Of 253 pregnancies with fetal CDH, 104 met the inclusion criteria, of whom 77 (74%) neonates survived to discharge. Seventy-five fetuses underwent both prenatal ultrasound and MRI. On multivariable analysis, observed/expected (o/e) lung-to-head ratio and o/e total fetal lung volume were associated independently with neonatal death (adjusted odds ratio, 0.89 (95% CI, 0.83-0.95) and 0.90 (95% CI, 0.84-0.97), respectively), whereas liver position was not. There was no significant difference in predictive performance between using ultrasound and MRI together (area under the receiver-operating-characteristics curve (AUC), 0.85 (95% CI, 0.76-0.93)) compared with using ultrasound alone (AUC, 0.81 (95% CI, 0.72-0.90); P = 0.19). The addition of neonatal parameters (gestational age at birth and small-for-gestational age) did not improve model performance (AUC, 0.87 (95% CI, 0.80-0.95)) compared with the combined ultrasound and MRI model (P = 0.22). There was poor agreement between severity assessment on ultrasound and MRI (Cohen's κ, 0.19). Most discrepancies were seen among cases deemed to be non-severe on ultrasound and severe on MRI, and outcomes were more consistent with MRI-based prognostication.

Conclusions: In fetuses with prenatally diagnosed isolated LCDH, mortality prediction using standardized ultrasound and MRI measurements performed reasonably well. In cases classified as non-severe on ultrasound, MRI is recommended, as it may provide more accurate prognostication and assist in the determination of candidacy for fetal intervention. © 2024 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

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来源期刊
CiteScore
12.30
自引率
14.10%
发文量
891
审稿时长
1 months
期刊介绍: Ultrasound in Obstetrics & Gynecology (UOG) is the official journal of the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) and is considered the foremost international peer-reviewed journal in the field. It publishes cutting-edge research that is highly relevant to clinical practice, which includes guidelines, expert commentaries, consensus statements, original articles, and systematic reviews. UOG is widely recognized and included in prominent abstract and indexing databases such as Index Medicus and Current Contents.
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