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How useful is the lung-to-head ratio in predicting outcome in the fetus with congenital diaphragmatic hernia? A systematic review and meta-analysis Ba'ath ME; Jesudason EC; Losty PDUltrasound Obstet Gynecol 2007[Nov]; 30 (6): 897-906OBJECTIVE: 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.|Cephalometry/methods[MESH]|Female[MESH]|Fetal Diseases/*diagnostic imaging[MESH]|Gestational Age[MESH]|Hernia, Diaphragmatic/*diagnostic imaging/mortality/surgery[MESH]|Humans[MESH]|Infant, Newborn[MESH]|Lung Volume Measurements/methods[MESH]|Male[MESH]|Predictive Value of Tests[MESH]|Pregnancy[MESH]|Pregnancy Outcome[MESH]|Pregnancy Trimester, Second[MESH]|Regression Analysis[MESH]|Ultrasonography[MESH] |
