Fetal lung volumes measured by MRI predict pulmonary morbidity among infants with giant omphaloceles

ObjectiveGiant omphaloceles (GO) have associated pulmonary hypoplasia and respiratory complications. Total lung volumes (TLV) on fetal MRI can prognosticate congenital diaphragmatic hernia outcomes; however, its applicability to GO is unknown. We hypothesize that late gestation TLV and observed-to-expected TLV (O/E TLV) on fetal MRI correlate with postnatal pulmonary morbidity in GO.MethodA single-institution retrospective review of GO evaluated between 2012 and 2022 was performed. Fetal MRI TLV between 32 and 36 weeks' gestation and O/E TLV throughout gestation were calculated and correlated with postnatal outcomes.Results86 fetuses with omphaloceles were evaluated; however, only 26 met strict inclusion criteria. MRIs occurred between 18 and 36 weeks' gestation. Those requiring delivery room intubation had significantly lower late gestation TLV and O/E TLV. O/E TLV predicted tracheostomy placement and survival. Neither TLV nor O/E TLV predicted the length of hospitalization or supplemental oxygen after discharge. Three fetuses had a TLV less than 35 mL: one died of respiratory failure, and the other two required tracheostomy.ConclusionsFetal MRI TLV measured between 32 and 36 weeks' gestation and O/E TLV predict the need for delivery room intubation and tracheostomy. O/E TLV correlated with survival. These data support fetal MRI as a prognostic tool to predict GO associated pulmonary morbidity. What's already known about this topic?Giant omphaloceles carry a higher risk of pulmonary morbidity, including the need for supplemental oxygen, prolonged mechanical ventilation, requirement for high-frequency oscillator ventilation, and need for tracheostomy.What does this study add?As pulmonary hypoplasia is a significant contributor to morbidity and mortality associated with GO, our study demonstrates that fetal MRI predicts respiratory requirements at the time of delivery. We demonstrate that O/E TLV measured by prenatal MRI is a useful tool to predict the need for immediate intubation within the delivery room as well as overall survival.

Automated summary

This study found that fetal MRI TLV and O/E TLV can predict the risk of respiratory complications in GO, supporting the use of fetal MRI as a prognostic tool for predicting GO-associated pulmonary morbidity.