Prenatal risk stratification for isolated congenital diaphragmatic hernia: results of a Japanese multicenter study

• Published in: Journal of pediatric surgery Vol. 46; no. 10; pp. 1873 - 1880
• Main Authors: Usui, Noriaki, Kitano, Yoshihiro, Okuyama, Hiroomi, Saito, Mari, Masumoto, Kouji, Morikawa, Nobuyuki, Takayasu, Hajime, Nakamura, Tomoo, Hayashi, Satoshi, Kawataki, Motoyoshi, Ishikawa, Hiroshi, Nose, Keisuke, Inamura, Noboru, Sago, Haruhiko
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.10.2011
• Subjects: Cesarean Section - utilization; Cohort Studies; Congenital diaphragmatic hernia; Extracorporeal Membrane Oxygenation - utilization; Female; Gestational Age; Hernia, Diaphragmatic - diagnostic imaging; Hernia, Diaphragmatic - embryology; Hernia, Diaphragmatic - mortality; Hernias, Diaphragmatic, Congenital; Humans; Japan - epidemiology; Liver - embryology; Lung - embryology; Male; Multicenter study; Pediatrics; Polyhydramnios - epidemiology; Pregnancy; Prenatal diagnosis; Prognosis; Prognostic classification; Retrospective Studies; Risk Assessment; Risk stratification; Stomach - embryology; Surgery; Survival Analysis; Ultrasonography, Prenatal; Congenital diaphragmatic hernia; Prenatal diagnosis; Multicenter study; Risk stratification; Prognostic classification
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1016/j.jpedsurg.2011.06.007

Abstract Background/Purpose The aim of this study was to establish a prenatal prognostic classification system for risk-stratified management in fetuses with isolated congenital diaphragmatic hernia (CDH). Methods A multi-institutional retrospective cohort study of isolated CDH, diagnosed prenatally in fetuses delivered during the 2002 to 2007 period at 5 participating institutions in Japan, was conducted. The risk stratification system was formulated based on the odds ratios of prenatal parameters for mortality at 90 days. The clinical severity in CDH infants were compared among the stratified risk groups. Results Patients were classified into the 3 risk groups: group A (n = 48) consisted of infants showing liver-down with contralateral lung–to–thorax transverse area ratio (L/T) ratio ≥0.08; group B of infants showing liver-down with L/T ratio <0.08 or liver-up with L/T ratio ≥0.08 (n = 35), and group C of infants showing liver-up with L/T ratio <0.08 (n = 20). The mortality at 90 days in groups A, B, and C were 0.0%, 20.0%, and 65.0%, respectively. The intact discharge rates were 95.8%, 60.0%, and 5.0%, respectively. This system also accurately reflected the clinical severity in CDH infants. Conclusions Our prenatal risk stratification system, which demonstrated a significant difference in postnatal status and final outcome, would allow for accurate estimation of the severity of disease in fetuses with isolated CDH, although it needs prospective validation in a different population.