Document Detail

How useful is the lung-to-head ratio in predicting outcome in the fetus with congenital diaphragmatic hernia? A systematic review and meta-analysis.
MedLine Citation:
PMID:  17963204     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: Fetal surgery to improve lung growth comprises tracheal occlusion in selected 'high-risk' fetuses with congenital diaphragmatic hernia (CDH). Sonographically measured fetal lung-to-head ratio (LHR) is utilized to recruit candidates for fetal surgery. This study provides a meta-analysis of the evidence regarding the prognostic use of lung-to-head ratio measurements in fetal CDH.
METHODS: MEDLINE, SCOPUS and ISI PROCEEDINGS databases were searched for MeSH terms: lung, head, hernia and ratio. References in retrieved studies were also searched. Studies were categorized as follows: Phase I studies measured normal fetal LHR; Phase II studies compared fetal LHR in CDH survivors and non-survivors (if LHR informed therapy decisions or LHR was not measured during the window for intervention (< 32 weeks' gestation), studies were excluded); Phase III studies used LHR to guide selection for fetal surgery (non-randomized trials were excluded); Phase IV studies measured CDH survival before and after LHR application in clinical practice.
RESULTS: The one Phase I study showed that LHR varied substantially with gestation and technique. No complete studies met the selection criteria for Phase II: meta-analysis of subgroups revealed similar LHR in CDH survivors and non-survivors. A single Phase III study revealed no benefit for LHR-directed fetal surgery. No Phase IV studies were identified.
CONCLUSION: The prognostic use of LHR in fetal CDH entered clinical practice prior to publication of robust normal data and is not supported by current evidence. Application of a structured approach to any 'new' prognostic test could improve its validity and clinical application.
M E Ba'ath; E C Jesudason; P D Losty
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Publication Detail:
Type:  Journal Article; Meta-Analysis; Review    
Journal Detail:
Title:  Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology     Volume:  30     ISSN:  0960-7692     ISO Abbreviation:  Ultrasound Obstet Gynecol     Publication Date:  2007 Nov 
Date Detail:
Created Date:  2007-11-01     Completed Date:  2008-03-04     Revised Date:  2014-02-19    
Medline Journal Info:
Nlm Unique ID:  9108340     Medline TA:  Ultrasound Obstet Gynecol     Country:  England    
Other Details:
Languages:  eng     Pagination:  897-906     Citation Subset:  IM    
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MeSH Terms
Cephalometry / methods
Fetal Diseases / ultrasonography*
Gestational Age
Hernia, Diaphragmatic / mortality,  surgery,  ultrasonography*
Infant, Newborn
Lung Volume Measurements / methods
Predictive Value of Tests
Pregnancy Outcome
Pregnancy Trimester, Second
Regression Analysis
Grant Support
G0802057//Medical Research Council

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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