Value of ultrasound in predicting the prognosis of congenital diaphragmatic hernia

Q4 Medicine

中华小儿外科杂志 Pub Date : 2019-11-15 DOI:10.3760/CMA.J.ISSN.0253-3006.2019.11.009

Zhou Lin, Ye Wanding, Zheng Jinjue, Zhao Qifeng, Cheng Xianwei, Wu Daozhu

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Abstract

Objective To explore the value of ultrasonic scan for predicting mortality in children with congenital diaphragmatic hernia (CDH). Methods Sixty-eight hospitalized CDH neonates were recruited and retrospectively analyzed from January 2010 to May 2017.Ultrasonic markers including sidedness of hernia, thoracic herniation of liver, thoracic herniation of stomach, diagnostic timing, presence of associated congenital anomalies, lung-to-head ratio (LHR) and observed/expected lung-to-head ratio (O/E LHR) were analyzed.And logistic regression analysis was performed for determining the independent predictors for mortality. Results The overall mortality rate was 39.7%(27/68). Differences existed in mortality between children with an intrathoracic liver, associated congenital anomalies and prenatally diagnosed as compared with those with an ectopic liver without anomalies and diagnosed postnatally (P 0.05). The mortality of patients with LHR≤1.4 was 50% higher than that with LHR >1.4 (P 45% (P<0.05). The area under the ROC curve for predicting mortality by LHR was 0.936 (95% CI, 0.837-1.000) and O/E LHR 0.880 (95% CI, 0.745-1.000). The value of LHR and O/E LHR for predicting mortality was not significantly different (z=0.044, P=0.483). Logistic multivariate regression analysis indicated that prenatal diagnosis, thoracic herniation of liver and associated congenital anomalies were independent predictors for mortality with odd ratios of 10.534, 8.843 and 11.234 respectively (P<0.05). Conclusions Ultrasound may become a useful tool of predicting the prognosis of CDH. Key words: Diaphragmatic hernia, congenital; Ultrasonography; Prognosis

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超声对先天性膈疝预后的预测价值

目的探讨超声扫描对先天性膈疝(CDH)患儿死亡率的预测价值。方法对2010年1月至2017年5月住院的68例CDH新生儿进行回顾性分析。分析超声指标包括疝气侧边度、胸段肝疝、胸段胃疝、诊断时机、是否存在相关先天性异常、肺头比(LHR)、观察/预期肺头比(O/E LHR)。并进行logistic回归分析以确定死亡率的独立预测因子。结果总死亡率为39.7%(27/68)。胸内肝、相关先天性异常和产前诊断的患儿与无异常和产后诊断的异位肝患儿的死亡率存在差异(p0.05)。LHR≤1.4的患者死亡率比LHR >1.4的患者高50% (P<0.05)。LHR预测死亡率的ROC曲线下面积为0.936 (95% CI, 0.837 ~ 1.000)， O/E LHR为0.880 (95% CI, 0.745 ~ 1.000)。LHR和O/E LHR对死亡率的预测价值差异无统计学意义(z=0.044, P=0.483)。Logistic多因素回归分析显示，产前诊断、胸段肝疝及相关先天性异常是死亡率的独立预测因素，奇比分别为10.534、8.843、11.234 (P<0.05)。结论超声可作为预测CDH预后的有效工具。关键词:膈疝;先天性;超声;预后

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来源期刊

中华小儿外科杂志 Medicine-Pediatrics, Perinatology and Child Health

CiteScore

0.40

自引率

0.00%

发文量

8707

期刊介绍： Chinese Journal of Pediatric Surgery is an academic journal sponsored by the Chinese Medical Association. It mainly publishes original research papers, reviews and comments in this field. The journal was founded in 1980 and is included in well-known databases such as Peking University Journal (Chinese Journal of Humanities and Social Sciences) and CSCD Chinese Science Citation Database Source Journal (including extended version). It is one of the national key academic journals under the supervision of the China Association for Science and Technology. Chinese Journal of Pediatric Surgery enjoys a high reputation and influence in the academic community. The articles published in this journal have a high academic level and practical value, providing readers with a large number of practical cases and industry information, and have received widespread attention and citations from readers.