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Prediction of Mortality and Need for Neonatal Extracorporeal Membrane Oxygenation in Fetuses with Congenital Diaphragmatic Hernia: Logistic Regression Analysis Based on MRI Fetal Lung Volume Measurements

¹ Department of Clinical Radiology, University Hospital Mannheim, University of Heidelberg, Theodor Kutzer Ufer 1-3, 68167 Mannheim, Germany.
² Department of Pediatrics, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany.

OBJECTIVE. The purpose of this study was to use logistic regression analysis of prenatal MRI fetal lung volume measurements to calculate mortality and the need for extracorporeal membrane oxygenation (ECMO) therapy among fetuses with congenital diaphragmatic hernia (CDH).

SUBJECTS AND METHODS. The fetal lung volume measurements of 65 fetuses with CDH were obtained between 32 and 34 weeks' gestation by means of MRI performed with multiplanar T2-weighted HASTE and true fast imaging with steady-state precession sequences. Logistic regression analysis was used to assess the prognostic value of the fetal lung volume measurements for prenatal prediction of fetal survival and need for neonatal ECMO.

RESULTS. Fetal lung volume was a highly significant predictor of survival (p < 0.0001) and neonatal ECMO requirement (p = 0.0006). The mortality was 84% and the ECMO requirement 80% among fetuses with a lung volume of 5 mL. The mortality was 0.4% and the ECMO requirement 20% among patients with a fetal lung volume of 30 mL.

CONCLUSION. Logistic regression analysis of MRI fetal lung volume measurements is highly valuable in predicting mortality among neonates with CDH, and it may help to estimate the need for neonatal ECMO. The method is feasible for facilitating parental guidance and may help in choosing postnatal therapeutic options, including ECMO therapy.

Keywords: congenital diaphragmatic hernia • ECMO • extracorporeal membrane oxygenation • fetal lung volume measurement • MRI

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