{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T03:38:35Z","timestamp":1783913915915,"version":"3.55.0"},"reference-count":33,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2018,2,7]],"date-time":"2018-02-07T00:00:00Z","timestamp":1517961600000},"content-version":"vor","delay-in-days":6,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp; Gyne"],"published-print":{"date-parts":[[2018,2]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>Congenital diaphragmatic hernia (CDH) is a severe anomaly. The observed\u2010to\u2010expected lung\u2010area\u2010to\u2010head\u2010circumference ratio (o\/e\u2010LHR) has been shown to provide a useful prediction of subsequent survival of fetuses with CDH in referral centers with expertise and a large caseload. However, the accuracy of o\/e\u2010LHR measurements in general fetal medicine units with less expertise is not well known. The aim of this study was to evaluate the capacity of o\/e\u2010LHR to provide a useful prediction of mortality of fetuses with CDH when the measurement is performed in fetal medicine units with different levels of expertise.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Between January 2008 and November 2013, 305 live births with expectantly managed left\u2010sided isolated CDH were recorded in the database of the French National Center for Rare Diseases (31 centers) and followed up after birth. Centers were grouped into two categories according to their mean annual CDH caseload over the study period: large centers with an average of \u2265\u200914 cases and smaller centers with &lt;\u200914 cases per year. The relationship between o\/e\u2010LHR and 28\u2010day and 6\u2010month mortality was modeled using fractional polynomials and the predictive value of o\/e\u2010LHR was quantified using the area under the receiver\u2013operating characteristics curve. Comparisons between the two center categories were carried out. Analyses were adjusted for potential confounders such as thoracic herniation of the liver and gestational age at birth and at diagnosis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>During the study period, two large centers managed a total of 82 CDH cases and 29 smaller centers a total of 223 CDH cases. Overall, there was a significant inverse relationship between 28\u2010day mortality rate and o\/e\u2010LHR, which decreased from 54% when o\/e\u2010LHR was 20% to 6% when o\/e\u2010LHR was 75% (<jats:italic>P<\/jats:italic>\u00a0&lt;\u20090.01). When the category of center was considered, adjusted associations between o\/e\u2010LHR and 28\u2010day mortality were significantly different (<jats:italic>P<\/jats:italic>\u00a0=\u20090.032) between large and smaller centers. The ability to predict survival at 28\u2009days postpartum based on o\/e\u2010LHR was better in large centers; for a specificity of 0.30, the sensitivity was 0.71 in large centers and 0.55 in smaller ones. The results were similar for 6\u2010month mortality.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Our results show that o\/e\u2010LHR measured on two\u2010dimensional ultrasound is a good indicator of neonatal prognosis in cases of CDH that may be used even in fetal medicine centers with a small caseload. However, our results also suggest that LHR measurement may be difficult to perform correctly. Therefore, appropriate training should be offered to professionals. Copyright \u00a9 2017 ISUOG. Published by John Wiley &amp; Sons Ltd.<\/jats:p><\/jats:sec>","DOI":"10.1002\/uog.17463","type":"journal-article","created":{"date-parts":[[2017,3,14]],"date-time":"2017-03-14T16:24:21Z","timestamp":1489508661000},"page":"208-213","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":51,"title":["Prognosis of isolated congenital diaphragmatic hernia using lung\u2010area\u2010to\u2010head\u2010circumference ratio: variability across centers in a national perinatal network"],"prefix":"10.1002","volume":"51","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2329-6575","authenticated-orcid":false,"given":"M.\u2010V.","family":"Senat","sequence":"first","affiliation":[{"name":"Center for Research in Epidemiology and Population Health (CESP), Universit\u00e9 Paris\u2010Saclay, Universit\u00e9 Paris\u2010Sud UVSQ, INSERM  Villejuif France"},{"name":"Centre Maladie Rare: Hernie de Coupole Diaphragmatique  Paris France"},{"name":"Department of Obstetrics and Gynecology H\u00f4pital Bic\u00eatre, AP\u2010HP, Universit\u00e9 Paris\u2010Sud  Le Kremlin\u2010Bic\u00eatre France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H.","family":"Bouchghoul","sequence":"additional","affiliation":[{"name":"Center for Research in Epidemiology and Population Health (CESP), Universit\u00e9 Paris\u2010Saclay, Universit\u00e9 Paris\u2010Sud UVSQ, INSERM  Villejuif France"},{"name":"Centre Maladie Rare: Hernie de Coupole Diaphragmatique  Paris France"},{"name":"Department of Obstetrics and Gynecology H\u00f4pital Bic\u00eatre, AP\u2010HP, Universit\u00e9 Paris\u2010Sud  Le Kremlin\u2010Bic\u00eatre France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.","family":"Stirnemann","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Maternal\u2010Fetal Medicine Necker\u2010Enfants Malades Hospital  AP\u2010HP Paris France"},{"name":"Universit\u00e9 Paris Descartes 5 CHU Lille, P\u00f4le Femme M\u00e8re Nouveau\u2010n\u00e9  Lille France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P.","family":"Vaast","sequence":"additional","affiliation":[{"name":"Centre Maladie Rare: Hernie de Coupole Diaphragmatique  Paris France"},{"name":"Universit\u00e9 Lille, EA 4489, Environnement P\u00e9rinatal et Sant\u00e9  Lille France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.","family":"Boubnova","sequence":"additional","affiliation":[{"name":"Centre Maladie Rare: Hernie de Coupole Diaphragmatique  Paris France"},{"name":"Service de Chirurgie P\u00e9diatrique H\u00f4pital de la Timone  Marseille France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L.","family":"Begue","sequence":"additional","affiliation":[{"name":"Service de Gyn\u00e9cologie\u2010Obst\u00e9trique Centre Hospitalier Universitaire  Montpellier France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E.","family":"Carricaburu","sequence":"additional","affiliation":[{"name":"Service de Chirurgie P\u00e9diatrique Hopital Robert Debr\u00e9  AP\u2010HP Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Sartor","sequence":"additional","affiliation":[{"name":"Service de Gyn\u00e9cologie\u2010Obst\u00e9trique Paule de Viguier Hospital  Toulouse France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.","family":"Jani","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology University Hospital Brugmann, Universit\u00e9 Libre de Bruxelles  Brussels Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Benachi","sequence":"additional","affiliation":[{"name":"Centre Maladie Rare: Hernie de Coupole Diaphragmatique  Paris France"},{"name":"Service de Gyn\u00e9cologie\u2010Obst\u00e9trique, H\u00f4pital Antoine B\u00e9cl\u00e8re, AP\u2010HP, Paris\u2010Sud Paris\u2010Saclay University  Clamart France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.","family":"Bouyer","sequence":"additional","affiliation":[{"name":"Center for Research in Epidemiology and Population Health (CESP), Universit\u00e9 Paris\u2010Saclay, Universit\u00e9 Paris\u2010Sud UVSQ, INSERM  Villejuif France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"for the Center for Rare Diseases: Congenital Diaphragmatic 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