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Jan Deprest - One of the best experts on this subject based on the ideXlab platform.
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the total trial dilemma a survey among professionals on equipoise regarding Fetal Therapy for severe congenital diaphragmatic hernia
Prenatal Diagnosis, 2021Co-Authors: Simen Vergote, Jan Deprest, Daniel Pizzolato, Francesca Russo, Kris Dierickx, Neeltje M T H CrombagAbstract:Objective Running randomized clinical trials (RCT) in Fetal Therapy is challenging. This is no different for fetoscopic endoluminal tracheal occlusion (FETO) for severe left-sided Congenital Diaphragmatic Hernia (CDH). We assessed the knowledge, attitude and practice (KAP) of maternal-Fetal medicine specialists toward the antenatal management of CDH, and the randomized controlled clinical (RCT) "Tracheal Occlusion To Accelerate Lung growth-trial." Methods A cross-sectional KAP-survey was conducted among 311 registrants of the 18th World Congress in Fetal Medicine. Results The overall knowledge of CDH and FETO was high. Remarkably only 45% considers prenatal prediction of neonatal outcome reliable. Despite, in their clinical practice they perform severity assessment (80%) and refer families for FETO either within the context of an RCT (43%) or on patient request (32%). Seventy percent perceives not offering FETO on patient demand seems as if no treatment is provided to a fetus with predicted poor outcome. Only 20% of respondents considers denying access to FETO on patient demand not as a psychological burden. Conclusion Often the views of individual respondents contradicted with their clinical practice. It seems that, for severe CDH, clinicians face personal and practical dilemmas that undermine equipoise. To us, this indicates the tension between the clinical and scientific obligations physicians experience.
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application of a postnatal prediction model of survival in cdh in the era of Fetal Therapy
Journal of Maternal-fetal & Neonatal Medicine, 2020Co-Authors: K Clohse, Jan Deprest, Maissa Rayyan, Herbert Decaluwe, Marc Gewillig, Anne DebeerAbstract:Background: The disease severity in patients with a congenital diaphragmatic hernia (CDH) is highly variable. To compare patient outcomes, set up clinical trials and come to severity-based treatment guidelines, a performant prediction tool early in neonatal life is needed.Objective: The primary purpose of this study was to validate the CDH study group (SG) prediction model for survival in neonates with CDH, including patients who had Fetal Therapy. Secondary, we aimed to assess its predictive value for early morbidity.Methods: This is a retrospective single-center study at the University Hospitals Leuven on all infants with a diagnosis of CDH live-born between April 2002 and December 2016. The prediction model of the CDHSG was applied to evaluate its performance in determining mortality risk. Besides, we examined its predictive value for early morbidity parameters, including duration of ventilation, respiratory support on day 30, time to full enteral feeding and length of hospital stay.Results: The CDHSG prediction model predicted survival well, with an area under the curve of 0.796 (CI: 0.720-0.871). It had poor value in predicting infants who needed respiratory support on day 30 (area under the curve (AUC) 0.606; CI: 0.493-0.719), and correlated poorly with duration of ventilation, time to full enteral feeding and length of hospital stay.Conclusion: The CDHSG prediction model was in our hands also a useful tool in predicting mortality in neonates with CDH in the Fetal treatment era. Correlation with early morbidity was poor.RationaleObjectives: (1) Validation of the CDHSG prediction model for survival in a cohort of neonates with CDH, in whom Fetal endoscopic tracheal occlusion was applied according to the severity of lung hypoplasia. (2) Evaluation of performance of the model in the prediction of early morbidity.Main results: (1) Confirmation of the predictive value of the model for survival in neonates with CDH in the era of Fetal Therapy. (2) No correlation of the model with early morbidity parameters.
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sars cov2 covid 19 infection is Fetal surgery in times of national disasters reasonable
Prenatal Diagnosis, 2020Co-Authors: Jan Deprest, Greg Ryan, Anna L. David, Marc Van Ranst, Lore Lannoo, Emma Bredaki, Jute Richter, Tim Van MieghemAbstract:Even though the global COVID-19 pandemic may affect how medical care is delivered in general, most countries try to maintain steady access for women to routine pregnancy care, including Fetal anomaly screening. This means that, also during this pandemic, Fetal anomalies will be detected, and that discussions regarding invasive genetic testing and possibly Fetal Therapy will need to take place. For patients, concerns about Severe Acute Respiratory Syndrome-Corona Virus 2 will add to the anxiety caused by the diagnosis of a serious Fetal anomaly. Yet, also for Fetal medicine teams the situation gets more complex as they must weigh up the risks and benefits to the fetus as well as the mother, while managing a changing evidence base and logistic challenges in their healthcare system.
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prenatal incision of ureterocele causing bladder outlet obstruction a multicenter case series
Prenatal Diagnosis, 2017Co-Authors: G E Chalouhi, Anne Maude Morency, Roland De Vlieger, J M Martinez, Thomas Blanc, Ryan Hodges, A Gueneuc, Greg Ryan, Jan DeprestAbstract:We reviewed data from a cohort of fetuses with ureterocele diagnosed and operated prenatally in four Fetal Therapy centers. Inclusion criteria were: (1)ureterocele confirmed on detailed Fetal ultrasound examination, (2)absence of additional Fetal malformations (3)Fetal intervention to decompress the ureterocele with local institutional review boards’ approval. Data on sonographic follow-up, obstetrical, neonatal outcome and postnatal evaluation were collected. Ten cases of prenatally treated ureterocele are described. Six cases benefited from a fetoscopy for laser incision and decompression, two cases had an ultrasound guided puncture before resorting to a fetoscopy with laser incision, one case had a balloon catheterization under ultrasound guidance and one case had an ultrasound-guided opening of the ureterocele with a laser fiber passed through a 20G needle. Mean GA at diagnosis was 21.6GW. Two cases underwent TOP. The remaining eight cases recovered normal amniotic fluid volume, and delivered a live-born child at a mean GA of 38.6GW with normal creatinine levels during the first week of life. Prenatal incision provided complete treatment of severely obstructive ureteroceles in 80% of the cases and allowed improvement of urinary electrolytes, renal size and echogenicity, bladder filling in all survivors and recollection of normal amniotic fluid volume, in case of oligoanhydramnios.
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Fetal treatment 2017 the evolution of Fetal Therapy centers a joint opinion from the international Fetal medicine and surgical society ifmss and the north american Fetal Therapy network naftnet
Fetal Diagnosis and Therapy, 2017Co-Authors: Anita J Moongrady, Jan Deprest, Stephen P. Emery, Ahmet Baschat, Mark I Evans, Timothy M Crombleholme, Darrell L Cass, Mahesh Choolani, Joshua A Copel, Francois I. LuksAbstract:More than 3 decades ago, a small group of physicians and other practitioners active in what they called "Fetal treatment" authored an opinion piece outlining the current status and future challenges anticipated in the field. Many advances in maternal, neonatal, and perinatal care and diagnostic and therapeutic modalities have been made in the intervening years, yet a thoughtful reassessment of the basic tenets put forth in 1982 has not been published. The present effort will aim to provide a framework for contemporary redefinition of the field of Fetal treatment, with a brief discussion of the necessary minimum expertise and systems base for the provision of different types of interventions for both the mother and fetus. Our goal will be to present an opinion that encourages the advancement of thoughtful practice, ensuring that current and future patients have realistic access to centers with a range of Fetal therapies with appropriate expertise, experience, and subspecialty and institutional support while remaining focused on excellence in care, collaborative scientific discovery, and maternal autonomy and safety.
Greg Ryan - One of the best experts on this subject based on the ideXlab platform.
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interrater agreement for sonographic stomach position classification in Fetal diaphragmatic hernia across the north american Fetal Therapy network
Prenatal Diagnosis, 2021Co-Authors: Nimrah Abbasi, Greg Ryan, Rodrigo Ruano, Magda Sanz Cortes, Prakesh S Shah, Alexandra Benachi, Roy A Filly, Anthony JohnsonAbstract:OBJECTIVE To evaluate inter-rater agreement for sonographic classification of stomach position (as a surrogate for liver herniation) in Fetal left congenital diaphragmatic hernia (LCDH) among: (i) Fetal medicine specialists from the North American Fetal Therapy Network (NAFTNet) centers within and without the Fetal endoscopic tracheal occlusion (FETO) consortium and in comparison to an expert external reviewer (ER1); and (iii) among two expert ERs (ER1 and ER2). METHODS Forty-eight physicians from 26 NAFTNet centers and 2 ERs were asked to assess 13 sonographic clips of isolated LCDH and classify stomach position as "intra-abdominal," "anterior left chest," "mid to posterior left chest," or "retro-cardiac" based on the classification published by Basta et al.8 Interrater agreement was assessed by determining proportion of stomach position ratings concordant amongst NAFTNet participants and ER1. Agreement for stomach position between ERs was calculated using kappa statistics. RESULTS Agreement for stomach position was 69% (39%-85%; n = 19) and 54% (23%-92%; n = 29) among FETO and non-FETO NAFTNet participants, respectively, when compared to ER1. Most disagreement in stomach position was related to a discrepancy of one position. ERs were in agreement for stomach position in 5 of 13 cases (38.5%) and inter-rater agreement was highest for "anterior" stomach position. CONCLUSION Interrater agreement for stomach position assessment in CDH was poor across NAFTNet and indeed amongst expert reviewers.
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inter rater agreement for sonographic stomach position classification in Fetal diaphragmatic hernia across the north american Fetal Therapy network naftnet
Prenatal Diagnosis, 2021Co-Authors: Nimrah Abbasi, Greg Ryan, Rodrigo Ruano, Magda Sanz Cortes, Prakesh S Shah, Alexandra Benachi, Roy A Filly, Anthony JohnsonAbstract:Objective To evaluate inter-rater agreement for sonographic classification of stomach position (as a surrogate for liver herniation) in Fetal left congenital diaphragmatic hernia (LCDH) among: (i) Fetal medicine specialists from the North American Fetal Therapy Network (NAFTNet) centres within and without the Fetal Endoscopic Tracheal Occlusion (FETO) consortium and in comparison to an expert external reviewer (ER1); and (iii) among two expert ERs (ER1 and ER2). Methods Forty-eight physicians from 26 NAFTNet centers and 2 ERs were asked to assess 13 sonographic clips of isolated LCDH and classify stomach position as "intra-abdominal", "anterior left chest", "mid to posterior left chest" or "retro-cardiac". Inter-rater agreement was assessed by determining proportion of stomach position ratings concordant amongst NAFTNet participants and ER 1. Agreement for stomach position between ERs was calculated using kappa statistics. Results Agreement for stomach position was 69% (39-85%; n=19) and 54% (23-92%; n=29) among FETO and non-FETO NAFTNet participants respectively, when compared to ER1. Most disagreement in stomach position was related to a discrepancy of one position. ERs were in agreement for stomach position in 5/13 cases (38.5%) and inter-rater agreement was highest for "anterior" position. Conclusion Inter-rater agreement for stomach position assessment in CDH was poor across NAFTNet and indeed amongst expert reviewers. This article is protected by copyright. All rights reserved.
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Fetal Therapy using rapamycin for a rapidly enlarging obstructive cervical lymphatic malformation a case report
Prenatal Diagnosis, 2021Co-Authors: Joel Livingston, Tim Van Mieghem, Nouf Alrowaily, Philip John, Paolo Campisi, Sebastian Ranguis, Manuel Carcao, Greg RyanAbstract:WHAT'S ALREADY KNOWN ABOUT THIS TOPIC?: Fetal lymphatic malformations (LMs) can be detected on prenatal ultrasound and until recently, therapeutic options were limited. Recently the mammalian target of rapamycin inhibitor rapamycin has emerged as a safe, effective Therapy for children with LMs and multiple studies have demonstrated improved efficacy if started early. WHAT DOES THIS STUDY ADD?: We report the first in-utero Therapy with rapamycin for a rapidly enlarging, obstructive, Fetal cervical LM. Fetal Therapy with rapamycin was safe and effective in managing this severe malformation, despite rapamycin being started only in the last 6.5 weeks of pregnancy. We speculate that had rapamycin been commenced earlier, the reduction in mass size might have been even greater.
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prenatal assessment of congenital diaphragmatic hernia at north american Fetal Therapy network centers a continued plea for standardization
Prenatal Diagnosis, 2021Co-Authors: Erin E Perrone, Greg Ryan, Nimrah Abbasi, Anthony Johnson, Magdalena Sanz Cortes, Uzma Umar, Maria Ladinotorres, Rodrigo RuanoAbstract:INTRODUCTION Prenatal work-up for congenital diaphragmatic hernia (CDH) is important for risk stratification, standardization, counseling, and optimal therapeutic choice. To determine current practice patterns regarding prenatal CDH work-up, including prenatal ultrasound and magnetic resonance imaging (MRI) use, and to identify areas for standardization of such evaluation between Fetal centers. METHODS A survey regarding prenatal CDH work-up was sent to each member center of the North American Fetal Therapy Network (NAFTNet) (n = 36). RESULTS All responded. Sonographic measurement of lung-to-head ratio (LHR) was determined by all, 89% (32/36) of which routinely calculate observed-to-expected LHR. The method for measuring LHR varied: 58% (21/36) used a "trace" method, 25% (9/36) used "longest axis," and 17% (6/36) used an "antero-posterior" method. Fetal MRI was routinely used in 78% (28/36) of centers, but there was significant variability in Fetal lung volume measurement. Whereas all generated a total Fetal lung volume, the planes, methodology and references values varied significantly. All evaluated liver position, 71% (20/28) evaluated stomach position and 54% (15/28) quantified the degree of liver herniation. More consistency in workup was seen between centers offering Fetal intervention. CONCLUSION Prenatal CDH work-up and management differs considerably among North American Fetal diagnostic centers, highlighting a need for its standardization.
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treatment and outcome in 370 cases with spontaneous or post laser twin anemia polycythemia sequence managed in 17 different Fetal Therapy centers
Ultrasound in Obstetrics & Gynecology, 2020Co-Authors: Lisanne S A Tollenaar, Greg Ryan, Y Ville, Femke Slaghekke, Liesbeth Lewi, M Lanna, A S Weingertner, S Arevalo, Asma KhalilAbstract:OBJECTIVE To investigate the antenatal management and outcome in a large international cohort of monochorionic twin pregnancies with spontaneous or post-laser twin anemia-polycythemia sequence (TAPS). METHODS This study analyzed data of monochorionic twin pregnancies diagnosed antenatally with spontaneous or post-laser TAPS in 17 Fetal Therapy centers, recorded in the TAPS Registry between 2014 and 2019. Antenatal diagnosis of TAPS was based on Fetal middle cerebral artery peak systolic velocity > 1.5 multiples of the median (MoM) in the TAPS donor and < 1.0 MoM in the TAPS recipient. The following antenatal management groups were defined: expectant management, delivery within 7 days after diagnosis, intrauterine transfusion (IUT) (with or without partial exchange transfusion (PET)), laser surgery and selective feticide. Cases were assigned to the management groups based on the first treatment that was received after diagnosis of TAPS. The primary outcomes were perinatal mortality and severe neonatal morbidity. The secondary outcome was diagnosis-to-birth interval. RESULTS In total, 370 monochorionic twin pregnancies were diagnosed antenatally with TAPS during the study period and included in the study. Of these, 31% (n = 113) were managed expectantly, 30% (n = 110) with laser surgery, 19% (n = 70) with IUT (± PET), 12% (n = 43) with delivery, 8% (n = 30) with selective feticide and 1% (n = 4) underwent termination of pregnancy. Perinatal mortality occurred in 17% (39/225) of pregnancies in the expectant-management group, 18% (38/215) in the laser group, 18% (25/140) in the IUT (± PET) group, 10% (9/86) in the delivery group and in 7% (2/30) of the cotwins in the selective-feticide group. The incidence of severe neonatal morbidity was 49% (41/84) in the delivery group, 46% (56/122) in the IUT (± PET) group, 31% (60/193) in the expectant-management group, 31% (57/182) in the laser-surgery group and 25% (7/28) in the selective-feticide group. Median diagnosis-to-birth interval was longest after selective feticide (10.5 (interquartile range (IQR), 4.2-14.9) weeks), followed by laser surgery (9.7 (IQR, 6.6-12.7) weeks), expectant management (7.8 (IQR, 3.8-14.4) weeks), IUT (± PET) (4.0 (IQR, 2.0-6.9) weeks) and delivery (0.3 (IQR, 0.0-0.5) weeks). Treatment choice for TAPS varied greatly within and between the 17 Fetal Therapy centers. CONCLUSIONS Antenatal treatment for TAPS differs considerably amongst Fetal Therapy centers. Perinatal mortality and morbidity were high in all management groups. Prolongation of pregnancy was best achieved by expectant management, treatment by laser surgery or selective feticide. © 2020 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.
Anthony Johnson - One of the best experts on this subject based on the ideXlab platform.
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interrater agreement for sonographic stomach position classification in Fetal diaphragmatic hernia across the north american Fetal Therapy network
Prenatal Diagnosis, 2021Co-Authors: Nimrah Abbasi, Greg Ryan, Rodrigo Ruano, Magda Sanz Cortes, Prakesh S Shah, Alexandra Benachi, Roy A Filly, Anthony JohnsonAbstract:OBJECTIVE To evaluate inter-rater agreement for sonographic classification of stomach position (as a surrogate for liver herniation) in Fetal left congenital diaphragmatic hernia (LCDH) among: (i) Fetal medicine specialists from the North American Fetal Therapy Network (NAFTNet) centers within and without the Fetal endoscopic tracheal occlusion (FETO) consortium and in comparison to an expert external reviewer (ER1); and (iii) among two expert ERs (ER1 and ER2). METHODS Forty-eight physicians from 26 NAFTNet centers and 2 ERs were asked to assess 13 sonographic clips of isolated LCDH and classify stomach position as "intra-abdominal," "anterior left chest," "mid to posterior left chest," or "retro-cardiac" based on the classification published by Basta et al.8 Interrater agreement was assessed by determining proportion of stomach position ratings concordant amongst NAFTNet participants and ER1. Agreement for stomach position between ERs was calculated using kappa statistics. RESULTS Agreement for stomach position was 69% (39%-85%; n = 19) and 54% (23%-92%; n = 29) among FETO and non-FETO NAFTNet participants, respectively, when compared to ER1. Most disagreement in stomach position was related to a discrepancy of one position. ERs were in agreement for stomach position in 5 of 13 cases (38.5%) and inter-rater agreement was highest for "anterior" stomach position. CONCLUSION Interrater agreement for stomach position assessment in CDH was poor across NAFTNet and indeed amongst expert reviewers.
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inter rater agreement for sonographic stomach position classification in Fetal diaphragmatic hernia across the north american Fetal Therapy network naftnet
Prenatal Diagnosis, 2021Co-Authors: Nimrah Abbasi, Greg Ryan, Rodrigo Ruano, Magda Sanz Cortes, Prakesh S Shah, Alexandra Benachi, Roy A Filly, Anthony JohnsonAbstract:Objective To evaluate inter-rater agreement for sonographic classification of stomach position (as a surrogate for liver herniation) in Fetal left congenital diaphragmatic hernia (LCDH) among: (i) Fetal medicine specialists from the North American Fetal Therapy Network (NAFTNet) centres within and without the Fetal Endoscopic Tracheal Occlusion (FETO) consortium and in comparison to an expert external reviewer (ER1); and (iii) among two expert ERs (ER1 and ER2). Methods Forty-eight physicians from 26 NAFTNet centers and 2 ERs were asked to assess 13 sonographic clips of isolated LCDH and classify stomach position as "intra-abdominal", "anterior left chest", "mid to posterior left chest" or "retro-cardiac". Inter-rater agreement was assessed by determining proportion of stomach position ratings concordant amongst NAFTNet participants and ER 1. Agreement for stomach position between ERs was calculated using kappa statistics. Results Agreement for stomach position was 69% (39-85%; n=19) and 54% (23-92%; n=29) among FETO and non-FETO NAFTNet participants respectively, when compared to ER1. Most disagreement in stomach position was related to a discrepancy of one position. ERs were in agreement for stomach position in 5/13 cases (38.5%) and inter-rater agreement was highest for "anterior" position. Conclusion Inter-rater agreement for stomach position assessment in CDH was poor across NAFTNet and indeed amongst expert reviewers. This article is protected by copyright. All rights reserved.
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prenatal assessment of congenital diaphragmatic hernia at north american Fetal Therapy network centers a continued plea for standardization
Prenatal Diagnosis, 2021Co-Authors: Erin E Perrone, Greg Ryan, Nimrah Abbasi, Anthony Johnson, Magdalena Sanz Cortes, Uzma Umar, Maria Ladinotorres, Rodrigo RuanoAbstract:INTRODUCTION Prenatal work-up for congenital diaphragmatic hernia (CDH) is important for risk stratification, standardization, counseling, and optimal therapeutic choice. To determine current practice patterns regarding prenatal CDH work-up, including prenatal ultrasound and magnetic resonance imaging (MRI) use, and to identify areas for standardization of such evaluation between Fetal centers. METHODS A survey regarding prenatal CDH work-up was sent to each member center of the North American Fetal Therapy Network (NAFTNet) (n = 36). RESULTS All responded. Sonographic measurement of lung-to-head ratio (LHR) was determined by all, 89% (32/36) of which routinely calculate observed-to-expected LHR. The method for measuring LHR varied: 58% (21/36) used a "trace" method, 25% (9/36) used "longest axis," and 17% (6/36) used an "antero-posterior" method. Fetal MRI was routinely used in 78% (28/36) of centers, but there was significant variability in Fetal lung volume measurement. Whereas all generated a total Fetal lung volume, the planes, methodology and references values varied significantly. All evaluated liver position, 71% (20/28) evaluated stomach position and 54% (15/28) quantified the degree of liver herniation. More consistency in workup was seen between centers offering Fetal intervention. CONCLUSION Prenatal CDH work-up and management differs considerably among North American Fetal diagnostic centers, highlighting a need for its standardization.
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variability in antenatal prognostication of Fetal diaphragmatic hernia across the north american Fetal Therapy network naftnet
Prenatal Diagnosis, 2020Co-Authors: Nimrah Abbasi, Michael V Zaretsky, Rodrigo Ruano, Ahmet Baschat, Magda Sanz Cortes, Tara A Morgan, Beverly G Coleman, Foongyen Lim, Anthony Johnson, Dorothy BulasAbstract:OBJECTIVE To evaluate variability in antenatal sonographic prognostication of congenital diaphragmatic hernia (CDH) within the North American Fetal Therapy Network (NAFTNet). METHODS NAFTNet centre were invited to complete a questionnaire and participate in videoconference calls, during which participants were observed while measuring lung area by ultrasound using the anteroposterior (AP) method, longest method, and trace method. Each center identified 1-2 experienced Fetal medicine specialist(s) or medical imaging specialists locally to participate in the study. Practices were compared among NAFTNet centre within and without the Fetal endoscopic tracheal occlusion (FETO) consortium. RESULTS Nineteen participants from 9 FETO center and 30 participants from 17 non-FETO center completed the survey and 31 participants were interviewed and observed while measuring sonographic lung area. All Centres measured observed-to-expected lung-to-head ratio (o/e LHR) or LHR for CDH prognostication. Image selection criteria for lung area measurement were consistent, including an axial section of the chest with clear lung borders and a 4-chamber cardiac view. Lung area measurement methods varied across NAFTNet, with most centre using longest (4/9 FETO vs. 13/29 non-FETO) or trace (3/9 FETO vs. 11/29 non-FETO) method. Centres differed in expected reference ranges for o/e LHR determination and whether the lowest, highest or average o/e LHR was utilized. CONCLUSION Variability in antenatal sonographic prognostication of CDH was identified across NAFTNet, indicating a need for consensus-based standardization.
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reproducibility of Fetal lung to head ratio in left diaphragmatic hernia across the north american Fetal Therapy network naftnet
Prenatal Diagnosis, 2019Co-Authors: Nimrah Abbasi, Greg Ryan, Magda Sanz Cortes, Anthony Johnson, Haleh Sangihaghpeykar, Prakesh S Shah, Alexandra Benachi, Julien Saada, Rodrigo RuanoAbstract:Objective To determine the antenatal sonographic lung area measurement method in left congenital diaphragmatic hernia (CDH) with the highest interrater agreement among North American Fetal Therapy Network (NAFTNet) centers within and outside the fetoscopic tracheal occlusion (FETO) consortium and in comparison with a European "expert" reviewer (ER). Methods Nineteen members from nine FETO consortium centers and 29 reviewers from 17 non-FETO centers reviewed ultrasound clips of the chest from 13 fetuses with isolated left CDH and were asked to select a static plane for lung area measurement using anteroposterior (AP), longest, and trace methods. Interrater agreement in lung area measurements was determined using intraclass correlation coefficient (ICC). Bland-Altman analysis was used to evaluate mean difference (bias) between NAFTNet reviewers and ER. Results Among FETO centers, agreement was highest using trace (ICC 0.94; 95% CI, 0.83-0.98), followed by longest (ICC 0.89; 95% CI, 0.75-0.97) and lowest for A-P (ICC 0.83; 95% CI, 0.67-0.94). Similar trends were noted in non-FETO centers. When compared with ER, bias was lowest for trace: 14 ± 38 mm2 and 19 ± 36 mm2 for FETO and non-FETO centers, respectively. Conclusion The trace method demonstrated the highest interrater agreement and lowest bias for lung area estimation in left CDH across NAFTNet.
Rodrigo Ruano - One of the best experts on this subject based on the ideXlab platform.
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interrater agreement for sonographic stomach position classification in Fetal diaphragmatic hernia across the north american Fetal Therapy network
Prenatal Diagnosis, 2021Co-Authors: Nimrah Abbasi, Greg Ryan, Rodrigo Ruano, Magda Sanz Cortes, Prakesh S Shah, Alexandra Benachi, Roy A Filly, Anthony JohnsonAbstract:OBJECTIVE To evaluate inter-rater agreement for sonographic classification of stomach position (as a surrogate for liver herniation) in Fetal left congenital diaphragmatic hernia (LCDH) among: (i) Fetal medicine specialists from the North American Fetal Therapy Network (NAFTNet) centers within and without the Fetal endoscopic tracheal occlusion (FETO) consortium and in comparison to an expert external reviewer (ER1); and (iii) among two expert ERs (ER1 and ER2). METHODS Forty-eight physicians from 26 NAFTNet centers and 2 ERs were asked to assess 13 sonographic clips of isolated LCDH and classify stomach position as "intra-abdominal," "anterior left chest," "mid to posterior left chest," or "retro-cardiac" based on the classification published by Basta et al.8 Interrater agreement was assessed by determining proportion of stomach position ratings concordant amongst NAFTNet participants and ER1. Agreement for stomach position between ERs was calculated using kappa statistics. RESULTS Agreement for stomach position was 69% (39%-85%; n = 19) and 54% (23%-92%; n = 29) among FETO and non-FETO NAFTNet participants, respectively, when compared to ER1. Most disagreement in stomach position was related to a discrepancy of one position. ERs were in agreement for stomach position in 5 of 13 cases (38.5%) and inter-rater agreement was highest for "anterior" stomach position. CONCLUSION Interrater agreement for stomach position assessment in CDH was poor across NAFTNet and indeed amongst expert reviewers.
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inter rater agreement for sonographic stomach position classification in Fetal diaphragmatic hernia across the north american Fetal Therapy network naftnet
Prenatal Diagnosis, 2021Co-Authors: Nimrah Abbasi, Greg Ryan, Rodrigo Ruano, Magda Sanz Cortes, Prakesh S Shah, Alexandra Benachi, Roy A Filly, Anthony JohnsonAbstract:Objective To evaluate inter-rater agreement for sonographic classification of stomach position (as a surrogate for liver herniation) in Fetal left congenital diaphragmatic hernia (LCDH) among: (i) Fetal medicine specialists from the North American Fetal Therapy Network (NAFTNet) centres within and without the Fetal Endoscopic Tracheal Occlusion (FETO) consortium and in comparison to an expert external reviewer (ER1); and (iii) among two expert ERs (ER1 and ER2). Methods Forty-eight physicians from 26 NAFTNet centers and 2 ERs were asked to assess 13 sonographic clips of isolated LCDH and classify stomach position as "intra-abdominal", "anterior left chest", "mid to posterior left chest" or "retro-cardiac". Inter-rater agreement was assessed by determining proportion of stomach position ratings concordant amongst NAFTNet participants and ER 1. Agreement for stomach position between ERs was calculated using kappa statistics. Results Agreement for stomach position was 69% (39-85%; n=19) and 54% (23-92%; n=29) among FETO and non-FETO NAFTNet participants respectively, when compared to ER1. Most disagreement in stomach position was related to a discrepancy of one position. ERs were in agreement for stomach position in 5/13 cases (38.5%) and inter-rater agreement was highest for "anterior" position. Conclusion Inter-rater agreement for stomach position assessment in CDH was poor across NAFTNet and indeed amongst expert reviewers. This article is protected by copyright. All rights reserved.
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prenatal assessment of congenital diaphragmatic hernia at north american Fetal Therapy network centers a continued plea for standardization
Prenatal Diagnosis, 2021Co-Authors: Erin E Perrone, Greg Ryan, Nimrah Abbasi, Anthony Johnson, Magdalena Sanz Cortes, Uzma Umar, Maria Ladinotorres, Rodrigo RuanoAbstract:INTRODUCTION Prenatal work-up for congenital diaphragmatic hernia (CDH) is important for risk stratification, standardization, counseling, and optimal therapeutic choice. To determine current practice patterns regarding prenatal CDH work-up, including prenatal ultrasound and magnetic resonance imaging (MRI) use, and to identify areas for standardization of such evaluation between Fetal centers. METHODS A survey regarding prenatal CDH work-up was sent to each member center of the North American Fetal Therapy Network (NAFTNet) (n = 36). RESULTS All responded. Sonographic measurement of lung-to-head ratio (LHR) was determined by all, 89% (32/36) of which routinely calculate observed-to-expected LHR. The method for measuring LHR varied: 58% (21/36) used a "trace" method, 25% (9/36) used "longest axis," and 17% (6/36) used an "antero-posterior" method. Fetal MRI was routinely used in 78% (28/36) of centers, but there was significant variability in Fetal lung volume measurement. Whereas all generated a total Fetal lung volume, the planes, methodology and references values varied significantly. All evaluated liver position, 71% (20/28) evaluated stomach position and 54% (15/28) quantified the degree of liver herniation. More consistency in workup was seen between centers offering Fetal intervention. CONCLUSION Prenatal CDH work-up and management differs considerably among North American Fetal diagnostic centers, highlighting a need for its standardization.
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variability in antenatal prognostication of Fetal diaphragmatic hernia across the north american Fetal Therapy network naftnet
Prenatal Diagnosis, 2020Co-Authors: Nimrah Abbasi, Michael V Zaretsky, Rodrigo Ruano, Ahmet Baschat, Magda Sanz Cortes, Tara A Morgan, Beverly G Coleman, Foongyen Lim, Anthony Johnson, Dorothy BulasAbstract:OBJECTIVE To evaluate variability in antenatal sonographic prognostication of congenital diaphragmatic hernia (CDH) within the North American Fetal Therapy Network (NAFTNet). METHODS NAFTNet centre were invited to complete a questionnaire and participate in videoconference calls, during which participants were observed while measuring lung area by ultrasound using the anteroposterior (AP) method, longest method, and trace method. Each center identified 1-2 experienced Fetal medicine specialist(s) or medical imaging specialists locally to participate in the study. Practices were compared among NAFTNet centre within and without the Fetal endoscopic tracheal occlusion (FETO) consortium. RESULTS Nineteen participants from 9 FETO center and 30 participants from 17 non-FETO center completed the survey and 31 participants were interviewed and observed while measuring sonographic lung area. All Centres measured observed-to-expected lung-to-head ratio (o/e LHR) or LHR for CDH prognostication. Image selection criteria for lung area measurement were consistent, including an axial section of the chest with clear lung borders and a 4-chamber cardiac view. Lung area measurement methods varied across NAFTNet, with most centre using longest (4/9 FETO vs. 13/29 non-FETO) or trace (3/9 FETO vs. 11/29 non-FETO) method. Centres differed in expected reference ranges for o/e LHR determination and whether the lowest, highest or average o/e LHR was utilized. CONCLUSION Variability in antenatal sonographic prognostication of CDH was identified across NAFTNet, indicating a need for consensus-based standardization.
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reproducibility of Fetal lung to head ratio in left diaphragmatic hernia across the north american Fetal Therapy network naftnet
Prenatal Diagnosis, 2019Co-Authors: Nimrah Abbasi, Greg Ryan, Magda Sanz Cortes, Anthony Johnson, Haleh Sangihaghpeykar, Prakesh S Shah, Alexandra Benachi, Julien Saada, Rodrigo RuanoAbstract:Objective To determine the antenatal sonographic lung area measurement method in left congenital diaphragmatic hernia (CDH) with the highest interrater agreement among North American Fetal Therapy Network (NAFTNet) centers within and outside the fetoscopic tracheal occlusion (FETO) consortium and in comparison with a European "expert" reviewer (ER). Methods Nineteen members from nine FETO consortium centers and 29 reviewers from 17 non-FETO centers reviewed ultrasound clips of the chest from 13 fetuses with isolated left CDH and were asked to select a static plane for lung area measurement using anteroposterior (AP), longest, and trace methods. Interrater agreement in lung area measurements was determined using intraclass correlation coefficient (ICC). Bland-Altman analysis was used to evaluate mean difference (bias) between NAFTNet reviewers and ER. Results Among FETO centers, agreement was highest using trace (ICC 0.94; 95% CI, 0.83-0.98), followed by longest (ICC 0.89; 95% CI, 0.75-0.97) and lowest for A-P (ICC 0.83; 95% CI, 0.67-0.94). Similar trends were noted in non-FETO centers. When compared with ER, bias was lowest for trace: 14 ± 38 mm2 and 19 ± 36 mm2 for FETO and non-FETO centers, respectively. Conclusion The trace method demonstrated the highest interrater agreement and lowest bias for lung area estimation in left CDH across NAFTNet.
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interrater agreement for sonographic stomach position classification in Fetal diaphragmatic hernia across the north american Fetal Therapy network
Prenatal Diagnosis, 2021Co-Authors: Nimrah Abbasi, Greg Ryan, Rodrigo Ruano, Magda Sanz Cortes, Prakesh S Shah, Alexandra Benachi, Roy A Filly, Anthony JohnsonAbstract:OBJECTIVE To evaluate inter-rater agreement for sonographic classification of stomach position (as a surrogate for liver herniation) in Fetal left congenital diaphragmatic hernia (LCDH) among: (i) Fetal medicine specialists from the North American Fetal Therapy Network (NAFTNet) centers within and without the Fetal endoscopic tracheal occlusion (FETO) consortium and in comparison to an expert external reviewer (ER1); and (iii) among two expert ERs (ER1 and ER2). METHODS Forty-eight physicians from 26 NAFTNet centers and 2 ERs were asked to assess 13 sonographic clips of isolated LCDH and classify stomach position as "intra-abdominal," "anterior left chest," "mid to posterior left chest," or "retro-cardiac" based on the classification published by Basta et al.8 Interrater agreement was assessed by determining proportion of stomach position ratings concordant amongst NAFTNet participants and ER1. Agreement for stomach position between ERs was calculated using kappa statistics. RESULTS Agreement for stomach position was 69% (39%-85%; n = 19) and 54% (23%-92%; n = 29) among FETO and non-FETO NAFTNet participants, respectively, when compared to ER1. Most disagreement in stomach position was related to a discrepancy of one position. ERs were in agreement for stomach position in 5 of 13 cases (38.5%) and inter-rater agreement was highest for "anterior" stomach position. CONCLUSION Interrater agreement for stomach position assessment in CDH was poor across NAFTNet and indeed amongst expert reviewers.
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inter rater agreement for sonographic stomach position classification in Fetal diaphragmatic hernia across the north american Fetal Therapy network naftnet
Prenatal Diagnosis, 2021Co-Authors: Nimrah Abbasi, Greg Ryan, Rodrigo Ruano, Magda Sanz Cortes, Prakesh S Shah, Alexandra Benachi, Roy A Filly, Anthony JohnsonAbstract:Objective To evaluate inter-rater agreement for sonographic classification of stomach position (as a surrogate for liver herniation) in Fetal left congenital diaphragmatic hernia (LCDH) among: (i) Fetal medicine specialists from the North American Fetal Therapy Network (NAFTNet) centres within and without the Fetal Endoscopic Tracheal Occlusion (FETO) consortium and in comparison to an expert external reviewer (ER1); and (iii) among two expert ERs (ER1 and ER2). Methods Forty-eight physicians from 26 NAFTNet centers and 2 ERs were asked to assess 13 sonographic clips of isolated LCDH and classify stomach position as "intra-abdominal", "anterior left chest", "mid to posterior left chest" or "retro-cardiac". Inter-rater agreement was assessed by determining proportion of stomach position ratings concordant amongst NAFTNet participants and ER 1. Agreement for stomach position between ERs was calculated using kappa statistics. Results Agreement for stomach position was 69% (39-85%; n=19) and 54% (23-92%; n=29) among FETO and non-FETO NAFTNet participants respectively, when compared to ER1. Most disagreement in stomach position was related to a discrepancy of one position. ERs were in agreement for stomach position in 5/13 cases (38.5%) and inter-rater agreement was highest for "anterior" position. Conclusion Inter-rater agreement for stomach position assessment in CDH was poor across NAFTNet and indeed amongst expert reviewers. This article is protected by copyright. All rights reserved.
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prenatal assessment of congenital diaphragmatic hernia at north american Fetal Therapy network centers a continued plea for standardization
Prenatal Diagnosis, 2021Co-Authors: Erin E Perrone, Greg Ryan, Nimrah Abbasi, Anthony Johnson, Magdalena Sanz Cortes, Uzma Umar, Maria Ladinotorres, Rodrigo RuanoAbstract:INTRODUCTION Prenatal work-up for congenital diaphragmatic hernia (CDH) is important for risk stratification, standardization, counseling, and optimal therapeutic choice. To determine current practice patterns regarding prenatal CDH work-up, including prenatal ultrasound and magnetic resonance imaging (MRI) use, and to identify areas for standardization of such evaluation between Fetal centers. METHODS A survey regarding prenatal CDH work-up was sent to each member center of the North American Fetal Therapy Network (NAFTNet) (n = 36). RESULTS All responded. Sonographic measurement of lung-to-head ratio (LHR) was determined by all, 89% (32/36) of which routinely calculate observed-to-expected LHR. The method for measuring LHR varied: 58% (21/36) used a "trace" method, 25% (9/36) used "longest axis," and 17% (6/36) used an "antero-posterior" method. Fetal MRI was routinely used in 78% (28/36) of centers, but there was significant variability in Fetal lung volume measurement. Whereas all generated a total Fetal lung volume, the planes, methodology and references values varied significantly. All evaluated liver position, 71% (20/28) evaluated stomach position and 54% (15/28) quantified the degree of liver herniation. More consistency in workup was seen between centers offering Fetal intervention. CONCLUSION Prenatal CDH work-up and management differs considerably among North American Fetal diagnostic centers, highlighting a need for its standardization.
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variability in antenatal prognostication of Fetal diaphragmatic hernia across the north american Fetal Therapy network naftnet
Prenatal Diagnosis, 2020Co-Authors: Nimrah Abbasi, Michael V Zaretsky, Rodrigo Ruano, Ahmet Baschat, Magda Sanz Cortes, Tara A Morgan, Beverly G Coleman, Foongyen Lim, Anthony Johnson, Dorothy BulasAbstract:OBJECTIVE To evaluate variability in antenatal sonographic prognostication of congenital diaphragmatic hernia (CDH) within the North American Fetal Therapy Network (NAFTNet). METHODS NAFTNet centre were invited to complete a questionnaire and participate in videoconference calls, during which participants were observed while measuring lung area by ultrasound using the anteroposterior (AP) method, longest method, and trace method. Each center identified 1-2 experienced Fetal medicine specialist(s) or medical imaging specialists locally to participate in the study. Practices were compared among NAFTNet centre within and without the Fetal endoscopic tracheal occlusion (FETO) consortium. RESULTS Nineteen participants from 9 FETO center and 30 participants from 17 non-FETO center completed the survey and 31 participants were interviewed and observed while measuring sonographic lung area. All Centres measured observed-to-expected lung-to-head ratio (o/e LHR) or LHR for CDH prognostication. Image selection criteria for lung area measurement were consistent, including an axial section of the chest with clear lung borders and a 4-chamber cardiac view. Lung area measurement methods varied across NAFTNet, with most centre using longest (4/9 FETO vs. 13/29 non-FETO) or trace (3/9 FETO vs. 11/29 non-FETO) method. Centres differed in expected reference ranges for o/e LHR determination and whether the lowest, highest or average o/e LHR was utilized. CONCLUSION Variability in antenatal sonographic prognostication of CDH was identified across NAFTNet, indicating a need for consensus-based standardization.
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reproducibility of Fetal lung to head ratio in left diaphragmatic hernia across the north american Fetal Therapy network naftnet
Prenatal Diagnosis, 2019Co-Authors: Nimrah Abbasi, Greg Ryan, Magda Sanz Cortes, Anthony Johnson, Haleh Sangihaghpeykar, Prakesh S Shah, Alexandra Benachi, Julien Saada, Rodrigo RuanoAbstract:Objective To determine the antenatal sonographic lung area measurement method in left congenital diaphragmatic hernia (CDH) with the highest interrater agreement among North American Fetal Therapy Network (NAFTNet) centers within and outside the fetoscopic tracheal occlusion (FETO) consortium and in comparison with a European "expert" reviewer (ER). Methods Nineteen members from nine FETO consortium centers and 29 reviewers from 17 non-FETO centers reviewed ultrasound clips of the chest from 13 fetuses with isolated left CDH and were asked to select a static plane for lung area measurement using anteroposterior (AP), longest, and trace methods. Interrater agreement in lung area measurements was determined using intraclass correlation coefficient (ICC). Bland-Altman analysis was used to evaluate mean difference (bias) between NAFTNet reviewers and ER. Results Among FETO centers, agreement was highest using trace (ICC 0.94; 95% CI, 0.83-0.98), followed by longest (ICC 0.89; 95% CI, 0.75-0.97) and lowest for A-P (ICC 0.83; 95% CI, 0.67-0.94). Similar trends were noted in non-FETO centers. When compared with ER, bias was lowest for trace: 14 ± 38 mm2 and 19 ± 36 mm2 for FETO and non-FETO centers, respectively. Conclusion The trace method demonstrated the highest interrater agreement and lowest bias for lung area estimation in left CDH across NAFTNet.