{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T10:26:01Z","timestamp":1789381561323,"version":"build-2803163510"},"reference-count":21,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2016,5,20]],"date-time":"2016-05-20T00:00:00Z","timestamp":1463702400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100001807","name":"Funda\u00e7\u00e3o de Amparo \u00e0 Pesquisa do Estado de S\u00e3o Paulo","doi-asserted-by":"publisher","award":["013\/12493-1"],"award-info":[{"award-number":["013\/12493-1"]}],"id":[{"id":"10.13039\/501100001807","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Ultrasound Medicine"],"published-print":{"date-parts":[[2016,7]]},"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>Liver herniation can be assessed sonographically by either a direct (liver\u2010to\u2010thoracic area ratio) or an indirect (stomach position) method. Our objective was to evaluate the utility of those methods to assess liver herniation for the prediction of neonatal outcomes in patients with isolated left\u2010sided congenital diaphragmatic hernia (CDH).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a retrospective cohort study of all patients with CDH who had prenatal assessment and were delivered at Texas Children's Hospital between January 2004 and April 2014. The predictive value of sonographic parameters for mortality and the need for extracorporeal membrane oxygenation was evaluated by univariate, multivariate, and factor analysis and by receiver operating characteristics curves.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 77 fetuses with isolated left\u2010sided CDH were analyzed. The lung\u2010to\u2010head ratio, liver\u2010to\u2010thorax ratio, and stomach position (according to the classifications of Kitano et al [<jats:italic>Ultrasound Obstet Gynecol<\/jats:italic> 2011; 37:277\u2013282] and Cordier et al [<jats:italic>J Matern Fetal Neonatal Med<\/jats:italic> 2015; 28:190\u2013195]) were significantly associated with both neonatal outcomes (<jats:italic>P<\/jats:italic> &lt; .03). Significant correlations were observed between all of these sonographic parameters. A combination of the liver\u2010to\u2010thorax ratio and stomach position (Kitano) or stomach position (Cordier) with the lung\u2010to\u2010head ratio increased the area under the receiver operating characteristic curve of the lung\u2010to\u2010head ratio for mortality prediction (0.86 [95% confidence interval, 0.74\u20130.98], 0.83 [0.72\u20130.95], and 0.83 [0.74\u20130.92], respectively).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Sonographic measurements of liver herniation (liver\u2010to\u2010thorax ratio and stomach position) are predictive of neonatal outcomes in isolated left\u2010sided congenital diaphragmatic hernia. Our study shows that the combination of those sonographic measurements of liver herniation and lung size improves the accuracy of predicting mortality in those fetuses.<\/jats:p><\/jats:sec>","DOI":"10.7863\/ultra.15.07020","type":"journal-article","created":{"date-parts":[[2016,5,23]],"date-time":"2016-05-23T17:33:34Z","timestamp":1464024814000},"page":"1437-1443","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":22,"title":["Improving the Prediction of Neonatal Outcomes in Isolated Left\u2010Sided Congenital Diaphragmatic Hernia by Direct and Indirect Sonographic Assessment of Liver Herniation"],"prefix":"10.1002","volume":"35","author":[{"given":"Nicolas","family":"Sananes","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ingrid","family":"Britto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adesola 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