Researchers at Children’s Hospital of Philadelphia (CHOP) identified new measurement thresholds to help predict the severity of congenital diaphragmatic hernia (CDH) – a severe birth defect where abdominal organs move into the chest hindering lung development – in fetuses. The work, performed using data from CHOP’s Clinical Outcomes Data Archive (CODA), was reported recently in the journal Prenatal Diagnosis.
“Our findings provide critical data as we evolve how we assess CDH severity in fetuses,” said Juliana Sanchez Gebb, MD, the study’s lead author, a maternal-fetal medicine specialist in the Richard D. Wood Jr. Center for Fetal Diagnosis and Treatment. “Our goal is to guide more precise and effective care.”
In the study, researchers analyzed data from 340 fetuses diagnosed with isolated left or right CDH between 2013 and 2023. Their goal was to refine the criteria used to predict survival and the need for extracorporeal membrane oxygenation (ECMO), a life-support technique used to treat severe cases.
The study focused on two key prenatal imaging measurements: the observed-to-expected lung to head ratio (O/E LHR) obtained via ultrasound and the observed-to-expected total lung volume (O/E TLV) measured through MRI. The metrics estimated fetal lung size relative to gestational age and are instrumental in assessing the severity of CDH.
For left-sided CDH, the researchers noted that an O/E LHR below 28.1% and an O/E TLV below 34% were associated with lower survival rates. In right-sided CDH cases, the critical thresholds were higher for O/E LHR (below 46.8%) but lower for O/E TLV (below 17.6%).
The study also found the higher O/E LHR and TLV values correlate with reduced reliance on ECMO, indicating improved breathing in newborns. The researchers noted that right-sided CDH may present differently, requiring specialized evaluation criteria.
“Tailoring assessment tools to better reflect outcomes allows for more informed prenatal intervention decisions,” said Holly Hedrick, MD, the senior author and a surgeon at CHOP. “Ultimately, we can improve survival and reduce the need for intensive postnatal support.”
Gebb et al. “Observed/Expected Lung-To-Head Ratio and Total Lung Volumes That Identify Fetuses with Severe Congenital Diaphragmatic Hernia in a North American Fetal Center” Prenatal Diagnosis. Online April 1, 2025. DOI: 10.1002/pd.6789.
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Researchers at Children’s Hospital of Philadelphia (CHOP) identified new measurement thresholds to help predict the severity of congenital diaphragmatic hernia (CDH) – a severe birth defect where abdominal organs move into the chest hindering lung development – in fetuses. The work, performed using data from CHOP’s Clinical Outcomes Data Archive (CODA), was reported recently in the journal Prenatal Diagnosis.
“Our findings provide critical data as we evolve how we assess CDH severity in fetuses,” said Juliana Sanchez Gebb, MD, the study’s lead author, a maternal-fetal medicine specialist in the Richard D. Wood Jr. Center for Fetal Diagnosis and Treatment. “Our goal is to guide more precise and effective care.”
In the study, researchers analyzed data from 340 fetuses diagnosed with isolated left or right CDH between 2013 and 2023. Their goal was to refine the criteria used to predict survival and the need for extracorporeal membrane oxygenation (ECMO), a life-support technique used to treat severe cases.
The study focused on two key prenatal imaging measurements: the observed-to-expected lung to head ratio (O/E LHR) obtained via ultrasound and the observed-to-expected total lung volume (O/E TLV) measured through MRI. The metrics estimated fetal lung size relative to gestational age and are instrumental in assessing the severity of CDH.
For left-sided CDH, the researchers noted that an O/E LHR below 28.1% and an O/E TLV below 34% were associated with lower survival rates. In right-sided CDH cases, the critical thresholds were higher for O/E LHR (below 46.8%) but lower for O/E TLV (below 17.6%).
The study also found the higher O/E LHR and TLV values correlate with reduced reliance on ECMO, indicating improved breathing in newborns. The researchers noted that right-sided CDH may present differently, requiring specialized evaluation criteria.
“Tailoring assessment tools to better reflect outcomes allows for more informed prenatal intervention decisions,” said Holly Hedrick, MD, the senior author and a surgeon at CHOP. “Ultimately, we can improve survival and reduce the need for intensive postnatal support.”
Gebb et al. “Observed/Expected Lung-To-Head Ratio and Total Lung Volumes That Identify Fetuses with Severe Congenital Diaphragmatic Hernia in a North American Fetal Center” Prenatal Diagnosis. Online April 1, 2025. DOI: 10.1002/pd.6789.
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