Prenatal risk stratification for isolated congenital diaphragmatic hernia: results of a Japanese multicenter study.
OBJECTIVE
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.
Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Osaka, Japan. usui@pedsurg.med.osaka-u.ac.jp
Noriaki
N
Usui
Yoshihiro
Y
Kitano
Hiroomi
H
Okuyama
Mari
M
Saito
Kouji
K
Masumoto
Nobuyuki
N
Morikawa
Hajime
H
Takayasu
Tomoo
T
Nakamura
Satoshi
S
Hayashi
Motoyoshi
M
Kawataki
Hiroshi
H
Ishikawa
Keisuke
K
Nose
Noboru
N
Inamura
Haruhiko
H
Sago
D002585:Cesarean Section / Q000706:statistics & numerical data; D015331:Cohort Studies; D015199:Extracorporeal Membrane Oxygenation / Q000706:statistics & numerical data; D005260:Female; D005865:Gestational Age; D006548:Hernia, Diaphragmatic / Q000000981:diagnostic imaging / Q000196:embryology* / Q000401:mortality; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008099:Liver / Q000196:embryology; D008168:Lung / Q000196:embryology; D008297:Male; D006831:Polyhydramnios / Q000453:epidemiology; D011247:Pregnancy; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D013270:Stomach / Q000196:embryology; D016019:Survival Analysis; D016216:Ultrasonography, Prenatal