TY - JOUR
T1 - Prediction of outcome by computer-assisted analysis of lung area on the chest radiograph of infants with congenital diaphragmatic hernia
AU - Dimitriou, G
AU - Greenough, A
AU - Davenport, M
AU - Nicolaides, K
PY - 2000/3
Y1 - 2000/3
N2 - Background/Purpose: Pulmonary hypoplasia is a major ca use of mortality and morbidity in infants with congenital diaphragmatic hernia (CDH). Pulmonary hypoplasia is characterized by low volume lungs, and affected infants are likely to have a low lung area on their chest radiograph, The authors assessed whether, in CDH infants, computer-assisted analysis of the chest radiograph lung area gave an accurate indication of lung volume, and if a low lung area was a better predictor of poor outcome (death or oxygen dependency at 28 days) than other test results. Methods: Comparisons were made of the radiographic lung area derived by computer-assisted analysis and lung volume, assessed by measurement of functional residual capacity (FRC) on day 1 before surgical intervention and on the first postoperative day. Compliance was measured, and the maximum and modified ventilation indices and maximum PaCO2 also was noted. Twenty-five CDH infants with a median gestational age of 38 weeks were studied; 18 had FRC measurements preoperatively. Results: Both preoperatively and postoperatively, the lung areas and FRCs correlated significantly (r = 0.51, P <.05; r = 0.76, P <.02, respectively). Eleven infants had a poor outcome (5 infants died without an operation); that group preoperatively differed significantly from those with a good outcome with respect to having a lower compliance (P <.02) and higher maximum ventilation index (P <.01) and maxi mum modified ventilation index (P <.05). Only postoperatively did infants with a poor outcome versus good outcome have a significantly lower lung area (P <.05); they also had a lower increase in lung area preoperatively to postoperatively (P <.01). Receiver operator characteristic curves were constructed; comparison of the areas under the curves showed that preoperatively, a low compliance and high ventilation index were the best predictors of poor outcome. Postoperatively, a low lung area performed as well as the ventilation indices. Conclusion: Computer-assisted analysis of the lung area on the chest radiograph is useful in predicting outcome in CDH infants postoperatively but not preoperatively. Copyright (C) 2000 by W.B. Saunders Company.
AB - Background/Purpose: Pulmonary hypoplasia is a major ca use of mortality and morbidity in infants with congenital diaphragmatic hernia (CDH). Pulmonary hypoplasia is characterized by low volume lungs, and affected infants are likely to have a low lung area on their chest radiograph, The authors assessed whether, in CDH infants, computer-assisted analysis of the chest radiograph lung area gave an accurate indication of lung volume, and if a low lung area was a better predictor of poor outcome (death or oxygen dependency at 28 days) than other test results. Methods: Comparisons were made of the radiographic lung area derived by computer-assisted analysis and lung volume, assessed by measurement of functional residual capacity (FRC) on day 1 before surgical intervention and on the first postoperative day. Compliance was measured, and the maximum and modified ventilation indices and maximum PaCO2 also was noted. Twenty-five CDH infants with a median gestational age of 38 weeks were studied; 18 had FRC measurements preoperatively. Results: Both preoperatively and postoperatively, the lung areas and FRCs correlated significantly (r = 0.51, P <.05; r = 0.76, P <.02, respectively). Eleven infants had a poor outcome (5 infants died without an operation); that group preoperatively differed significantly from those with a good outcome with respect to having a lower compliance (P <.02) and higher maximum ventilation index (P <.01) and maxi mum modified ventilation index (P <.05). Only postoperatively did infants with a poor outcome versus good outcome have a significantly lower lung area (P <.05); they also had a lower increase in lung area preoperatively to postoperatively (P <.01). Receiver operator characteristic curves were constructed; comparison of the areas under the curves showed that preoperatively, a low compliance and high ventilation index were the best predictors of poor outcome. Postoperatively, a low lung area performed as well as the ventilation indices. Conclusion: Computer-assisted analysis of the lung area on the chest radiograph is useful in predicting outcome in CDH infants postoperatively but not preoperatively. Copyright (C) 2000 by W.B. Saunders Company.
UR - http://www.scopus.com/inward/record.url?scp=0034108308&partnerID=8YFLogxK
U2 - 10.1016/S0022-3468(00)90219-7
DO - 10.1016/S0022-3468(00)90219-7
M3 - Article
VL - 35
SP - 489
EP - 493
JO - Journal of Pediatric Surgery
JF - Journal of Pediatric Surgery
IS - 3
ER -