{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T03:38:32Z","timestamp":1783913912852,"version":"3.55.0"},"reference-count":36,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2021,10,1]],"date-time":"2021-10-01T00:00:00Z","timestamp":1633046400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp;amp; Gyne"],"published-print":{"date-parts":[[2021,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>In fetuses with isolated left\u2010sided congenital diaphragmatic hernia (LCDH), prenatal detection of severe pulmonary hypoplasia is important, as fetal therapy can improve survival. Cases with mild or moderate lung hypoplasia still carry a considerable risk of mortality and morbidity, but there has been less interest in the accurate prediction of outcome in these cases. In this study of fetuses with mild or moderate isolated LCDH, we aimed to investigate: (1) the association between intrapulmonary artery (IPA) Doppler findings and mortality at discharge; (2) whether adding IPA Doppler findings improves the prediction of mortality based on lung size and liver herniation; and (3) the association between IPA Doppler findings and early neonatal morbidity.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a retrospective study of all consecutive fetuses assessed at the BCNatal and UZ Leuven hospitals between 2008 and 2020 with a prenatal diagnosis of isolated, non\u2010severe LCDH, defined as observed\u2010to\u2010expected lung\u2010to\u2010head ratio (o\/e\u2010LHR) &gt;\u200925%, that were managed expectantly during pregnancy followed by standardized neonatal management. An additional inclusion criterion was the availability of IPA Doppler measurements. The primary outcome was the association between IPA Doppler findings and mortality at discharge. Other predictors included o\/e\u2010LHR, liver herniation and gestational age at birth. Secondary outcomes were the association between IPA Doppler findings and the presence of pulmonary hypertension (PHT), need for supplemental oxygen at discharge and need for extracorporeal membrane oxygenation. IPA pulsatility index (PI) values were converted into <jats:italic>Z<\/jats:italic>\u2010scores. Logistic regression analysis was performed to investigate the associations between predictor variables and outcome, and the best model was chosen based on the Nagelkerke <jats:italic>R<\/jats:italic><jats:sup>2<\/jats:sup>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Observations for 70 non\u2010severe LCDH cases were available. Fifty\u2010four (77%) fetuses survived until discharge. On logistic regression analysis, higher IPA\u2010PI was associated with an increased risk of mortality (odds ratio (OR), 3.96 (95%\u2009CI, 1.62\u20139.70)), independently of o\/e\u2010LHR (OR, 0.87 (95%\u2009CI, 0.79\u20130.97)). An IPA\u2010PI <jats:italic>Z<\/jats:italic>\u2010score cut\u2010off of 1.8 predicted mortality with a detection rate of 69% and specificity of 93%. Adding IPA\u2010PI to o\/e\u2010LHR improved significantly the model's performance (Nagelkerke <jats:italic>R<\/jats:italic><jats:sup>2<\/jats:sup>, 46% for o\/e\u2010LHR\u2009+\u2009IPA\u2010PI <jats:italic>vs<\/jats:italic> 28% for o\/e\u2010LHR (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.002)), with a detection rate of 81% at a 10% false\u2010positive rate. IPA\u2010PI was associated with PHT (OR, 2.20 (95%\u2009CI, 1.01\u20134.59)) and need for oxygen supplementation at discharge (OR, 1.90 (95%\u2009CI, 1.10\u20133.40)), independently of lung size.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In fetuses with mild or moderate LCDH, IPA\u2010PI was associated with mortality and morbidity, independently of lung size. A model combining o\/e\u2010LHR with IPA\u2010PI identified up to four in five cases that eventually died, despite being considered to have non\u2010severe pulmonary hypoplasia. \u00a9 2021 International Society of Ultrasound in Obstetrics and Gynecology.<\/jats:p><\/jats:sec>","DOI":"10.1002\/uog.23701","type":"journal-article","created":{"date-parts":[[2021,6,5]],"date-time":"2021-06-05T21:19:35Z","timestamp":1622927975000},"page":"590-596","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":20,"title":["Intrapulmonary artery Doppler to predict mortality and morbidity in fetuses with mild or moderate left\u2010sided congenital diaphragmatic hernia"],"prefix":"10.1002","volume":"58","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2022-9027","authenticated-orcid":false,"given":"D.","family":"Basurto","sequence":"first","affiliation":[{"name":"My FetUZ Department of Development and Regeneration, Cluster Woman and Child, Biomedical Sciences KU Leuven  Leuven Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2422-2623","authenticated-orcid":false,"given":"J.","family":"Fuenzalida","sequence":"additional","affiliation":[{"name":"Fetal i+D Fetal Medicine Research Center, BCNatal\u2013Barcelona Center for Maternal\u2013Fetal and Neonatal Medicine (Hospital Cl\u00ednic and Hospital Sant Joan de Deu), Institut Cl\u00ednic de Ginecologia, Obstetricia i Neonatologia, Institut d'Investigacions Biom\u00e8diques August Pi i Sunyer Universitat de Barcelona  Barcelona Spain"},{"name":"Centre for Biomedical Research on Rare Diseases (CIBER\u2010ER)  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4711-3857","authenticated-orcid":false,"given":"R. J.","family":"Martinez\u2010Portilla","sequence":"additional","affiliation":[{"name":"Fetal i+D Fetal Medicine Research Center, BCNatal\u2013Barcelona Center for Maternal\u2013Fetal and Neonatal Medicine (Hospital Cl\u00ednic and Hospital Sant Joan de Deu), Institut Cl\u00ednic de Ginecologia, Obstetricia i Neonatologia, Institut d'Investigacions Biom\u00e8diques August Pi i Sunyer Universitat de Barcelona  Barcelona Spain"},{"name":"Centre for Biomedical Research on Rare Diseases (CIBER\u2010ER)  Barcelona Spain"},{"name":"Centre for Evidence\u2010Based Medicine, Nuffield Department of Primary Health Sciences University of Oxford  Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F. M.","family":"Russo","sequence":"additional","affiliation":[{"name":"My FetUZ Department of Development and Regeneration, Cluster Woman and Child, Biomedical Sciences KU Leuven  Leuven Belgium"},{"name":"Clinical Department of Obstetrics and Gynaecology University Hospitals Leuven  Leuven Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Pertierra","sequence":"additional","affiliation":[{"name":"Centre for Biomedical Research on Rare Diseases (CIBER\u2010ER)  Barcelona Spain"},{"name":"Clinical Department of Neonatology Sant Joan de D\u00e9u University Hospital  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. M.","family":"Mart\u00ednez","sequence":"additional","affiliation":[{"name":"Fetal i+D Fetal Medicine Research Center, BCNatal\u2013Barcelona Center for Maternal\u2013Fetal and Neonatal Medicine (Hospital Cl\u00ednic and Hospital Sant Joan de Deu), Institut Cl\u00ednic de Ginecologia, Obstetricia i Neonatologia, Institut d'Investigacions Biom\u00e8diques August Pi i Sunyer Universitat de Barcelona  Barcelona Spain"},{"name":"Centre for Biomedical Research on Rare Diseases (CIBER\u2010ER)  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4920-945X","authenticated-orcid":false,"given":"J.","family":"Deprest","sequence":"additional","affiliation":[{"name":"My FetUZ Department of Development and Regeneration, Cluster Woman and Child, Biomedical Sciences KU Leuven  Leuven Belgium"},{"name":"Clinical Department of Obstetrics and Gynaecology University Hospitals Leuven  Leuven Belgium"},{"name":"Institute for Women's Health 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d'Investigacions Biom\u00e8diques August Pi i Sunyer Universitat de Barcelona  Barcelona Spain"},{"name":"Centre for Biomedical Research on Rare Diseases (CIBER\u2010ER)  Barcelona 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