Clinical usefulness Adverse fetal outcomes in patients with IUGR are related with fetal diaphragm evaluation parameters Gokhan Acmaz a,⇑ , Fatma Ozdemir a , Erdem Sahin a , Mefkure Eraslan Sahin b , Yusuf Madendag a , Tugce Baykara Demir a , Erol Karakas a , Iptisam Ipek Muderris a , Mustafa Nisari c , Evrim Bayraktar d a Erciyes University Medicine Facility, Obstetrics and Gynecology Department, Turkey b Kayseri Training and Research Hospital, Obstetrics and Gynecology Department, Turkey c Nuh Naci Yazgan University Health Science Facility, Department of Nutrition and Dietetics, Turkey d Erciyes University Health Science Facility, Department of Midwifery, Turkey Educational aims The reader will be able to:  Appreciate that diaphragm ultrasound is an effective method for the prediction of neonatal outcomes in complicated pregnancies  Appreciate which diaphragm ultrasonography measurements may be more useful to assess fetal outcomes  Understand that structural and functional changes in the diaphragm have an important effect on fetal outcomes in patients with intrauterine growth retardation. article info Keywords: IUGR Diaphragmatic thickness Diaphragmatic excursion Diaphragm thickening fraction abstract Introduction: The aim of the present study was to evaluate the relationship between diaphragmatic thickness, during both inspiratory (DTI) and expiratory (DTE) stages; diaphragmatic excursion (DE); diaphragm thickening fraction (DTF); and adverse fetal outcomes in pregnant women with intrauterine growth restriction (IUGR). Materials and methods: A total of 77 participants were included in this case-control study. The case group was diagnosed as having both symmetric and asymmetric IUGR (n = 39). The control group included gestational age (GA)-matched healthy pregnant women (n = 38). DTI, DTE, DE (reflecting the capability of diaphragmatic movement during the respiratory cycle), and DTF were analyzed. Results: Maternal demographic characteristics were similar between groups. DTI and DTE were significantly lower in the IUGR group compared to the control group (p < 0.001 and p < 0.001). DE was similar between the groups (p = 0.07). Additionally, in the IUGR group, DTI, DTE, and DE were significantly altered in newborns that required treatment in the neonatal intensive care unit (NICU). ROC curve analysis determined that the DTI cut-off was 1.36 for NICU admission with 78% sensitivity and 100% specificity. DTE cut-off was 1.195 for NICU admission with 78% sensitivity and 96% specificity. DE cut-off was 4.25 for NICU admission with 71% sensitivity and 80% specificity. Conclusion: Measurement of DTI, DTE and DE may help clinicians to predict whether newborns with IUGR would require NICU hospitalization. Ó 2020 Elsevier Ltd. All rights reserved. INTRODUCTION Diaphragm ultrasound (DUS) is a new technique that has allowed further characterization of the morphology and function of the diaphragm and has attracted the attention of researchers in recent years. Diaphragm ultrasonography is a noninvasive imag- ing method in which both diaphragm excursion and thickness can be evaluated. The diaphragmatic thickening ratio is a measure of the diaphragm’s contractile capacity, possibly reflecting its strength [1]. In critically ill adult patients, the DUS technique sup- plies valuable information concerning severe diaphragm weakness [2,3]. Moreover, diaphragm thickness (DT) and diaphragm thick- https://doi.org/10.1016/j.prrv.2020.07.005 1526-0542/Ó 2020 Elsevier Ltd. All rights reserved. ⇑ Corresponding author at: Erciyes University Hospital Department of Obstetrics and Gynecology, 38010Melikgazi, Kayseri, Turkey. E-mail address: gokhanacmaz@gmail.com (G. Acmaz). Paediatric Respiratory Reviews xxx (xxxx) xxx Contents lists available at ScienceDirect Paediatric Respiratory Reviews Please cite this article as: G. Acmaz, F. Ozdemir, E. Sahin et al., Adverse fetal outcomes in patients with IUGR are related with fetal diaphragm evaluation parameters, Paediatric Respiratory Reviews, https://doi.org/10.1016/j.prrv.2020.07.005