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Oral Concurrent Session 8 - Fetus and Fetal Intervention

Oral Concurrent Sessions

Oral Concurrent Session 8 - Fetus and Fetal Intervention

(87) Predicting Outcomes in Congenital Diaphragmatic Hernia with Discordant Fetal MRI and Ultrasound Prognostic Indices

Saturday, February 1, 2025

8:15 AM – 8:30 AM

Location: Aurora Ballroom B, Lobby Level

Submitting Author and Presenting Author(s)

Lamia A. Alamri, MD

Fellow
University of Colorado, School of Medicine
Aurora, Colorado, United States

Coauthor(s)

JG

Jason Gien, MD

Professor, Neonatology
University of Colorado, School of Medicine
Aurora, Colorado, United States
PM

Payton Moody

Medical Student
University of Colorado, School of Medicine
Aurora, Colorado, United States
BW

Blair W. Weikel

University of Colorado, School of Medicine and Colorado Fetal Care Center
Aurora, Colorado, United States
Mariana Meyers, MD (she/her/hers)

Associate Professor, Radiology
University of Colorado, School of Medicine
Aurora, Colorado, United States
Michael V. Zaretsky, MD (he/him/his)

Professor, Maternal Fetal Medicine
University of Colorado, School of Medicine
Aurora, Colorado, United States
SD

Sarkis C. Derderian, MD

Assistant Professor, Surgery
University of Colorado, School of Medicine
Aurora, Colorado, United States
Henry L. Galan, MD

Professor, Maternal Fetal Medicine
University of Colorado, School of Medicine, Children's Hospital of Colorado
Aurora, Colorado, United States

Objective: Prognosis and management of prenatally diagnosed congenital diaphragmatic hernia (CDH) is reliant on ultrasound (US) observed-to-expected lung-to-head ratio (O/E LHR) and MRI indices (percent predicted lung volume; PPLV). These indices can conflict with one another (e.g. severe by MRI and moderate by US, or vice versa), creating a clinical dilemma. Our objective was to determine whether discordant prognostic indices are more predictive of a moderate or a severe case.

Study Design: This retrospective study included all severe and moderate CDH cases managed at a single fetal care center from 2012-2023. Severe parameters were defined as a MRI PPLV < 15% and U/S O/E LHR value < 25%. Discordant MRI and US indices (DIS) were defined as either one falling into the severe category and the other into the moderate category, and they were grouped together. Concordant Severe (CSev) and Concordant Moderate (CMod) were defined as MRI and US both falling into the severe or moderate category, respectively. The primary outcome was extracorporeal membrane oxygenation (ECMO) use. Categorical and continuous variables were compared using chi-square or Fisher’s exact tests or Wilcoxon rank sum test as appropriate. Differences between groups were assessed with pair-wise comparisons and a Bonferroni correction (p< 0.017).

Results: Of 82 CDH cases, 27 were in the DIS group, 36 in the CMod group and 19 in the CSev group. Primary and secondary outcomes are shown in the Table 1a. ECMO use was similar for DIS (78%) and CSev (95%) groups, and both were significantly higher (Table 1b) than the CMod group (45%). Survival was highest and mechanical ventilation was lowest in the CMod group (Table1 & Figure1). Duration on ECMO and hospital length of stay were similar among all groups.

Conclusion: Discordant prenatal MRI and US CDH indices can lead to uncertainty and affect optimal patient counseling and management. Our results suggest that MRI and US modalities which show discordant CDH prognostic indices, predict a severe CDH phenotype.