title: Prenatal and postnatal markers of severity in congenital diaphragmatic hernia have similar prognostic ability.
abstract: OBJECTIVE
  The purpose of this study was to compare prenatal versus postnatal markers of congenital diaphragmatic hernia (CDH) severity at a single fetal-care center.
  
  
  METHODS
  A retrospective study was performed of patients having a complete prenatal evaluation and surgical repair (n = 55). Observed-to-expected lung-to-head ratio (o/eLHR), observed-to-expected total lung volume (o/eTLV), liver position (LP), a predictive dependent variable from logistic regression of o/eLHR and liver position (o/eLHR + LP), and diaphragmatic defect size per the CDH Study Group A-D classification were plotted into receiver-operating characteristics (ROC) curves. Survival and need for extracorporeal membrane oxygenation (ECMO) were primary outcomes.
  
  
  RESULTS
  Survival was 69%, and ECMO utilization was 56%. Distribution was 80% left-sided defects. In the survival ROC curve, the area under the curve (AUC) for o/eLHR was 0.73, o/eTLV 0.74, LP 0.73, o/eLHR + LP 0.78, and defect size 0.84 (p = 0.23). The ROC curve for ECMO support showed o/eLHR had an AUC of 0.82, o/eTLV 0.89, LP 0.79, o/eLHR + LP 0.87, and defect size 0.90 (p = 0.19). The AUCs were similar when only left-sided CDH was analyzed.
  
  
  CONCLUSIONS
  These data suggest that prenatal evaluation was equivalent to the postnatal diaphragmatic defect classification for predicting survival and need for ECMO in CDH patients.
authors.affiliation: Section of Pediatric Surgery, Department of Surgery, The University of Michigan Medical School and The C.S. Mott Children's Hospital and the Fetal Diagnosis and Treatment Center, Ann Arbor, Michigan, USA.
authors.forename: N L
authors.initials: NL
authors.lastname: Werner
authors.affiliation: Section of Pediatric Surgery, Department of Surgery, The University of Michigan Medical School and The C.S. Mott Children's Hospital and the Fetal Diagnosis and Treatment Center, Ann Arbor, Michigan, USA.
authors.forename: M
authors.initials: M
authors.lastname: Coughlin
authors.affiliation: Section of Pediatric Surgery, Department of Surgery, The University of Michigan Medical School and The C.S. Mott Children's Hospital and the Fetal Diagnosis and Treatment Center, Ann Arbor, Michigan, USA.
authors.forename: S M
authors.initials: SM
authors.lastname: Kunisaki
authors.affiliation: Section of Pediatric Surgery, Department of Surgery, The University of Michigan Medical School and The C.S. Mott Children's Hospital and the Fetal Diagnosis and Treatment Center, Ann Arbor, Michigan, USA.
authors.forename: R
authors.initials: R
authors.lastname: Hirschl
authors.affiliation: Section of Pediatric Radiology, Department of Radiology, The University of Michigan Medical School and The C.S. Mott Children's Hospital and the Fetal Diagnosis and Treatment Center, Ann Arbor, Michigan, USA.
authors.forename: M
authors.initials: M
authors.lastname: Ladino-Torres
authors.affiliation: Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, The University of Michigan Medical School and The C.S. Mott Children's Hospital and the Fetal Diagnosis and Treatment Center, Ann Arbor, Michigan, USA.
authors.forename: D
authors.initials: D
authors.lastname: Berman
authors.affiliation: Section of Pediatric Surgery, Department of Surgery, The University of Michigan Medical School and The C.S. Mott Children's Hospital and the Fetal Diagnosis and Treatment Center, Ann Arbor, Michigan, USA.
authors.forename: J
authors.initials: J
authors.lastname: Kreutzman
authors.affiliation: Section of Pediatric Surgery, Department of Surgery, The University of Michigan Medical School and The C.S. Mott Children's Hospital and the Fetal Diagnosis and Treatment Center, Ann Arbor, Michigan, USA.
authors.forename: G B
authors.initials: GB
authors.lastname: Mychaliska
mesh_terms: D000015:Abnormalities, Multiple / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality / Q000628:therapy; D015199:Extracorporeal Membrane Oxygenation / Q000706:statistics & numerical data*; D005260:Female; D005865:Gestational Age; D006257:Head / Q000000981:diagnostic imaging* / Q000473:pathology; D065630:Hernias, Diaphragmatic, Congenital / Q000150:complications / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D059685:Herniorrhaphy; D006801:Humans; D007231:Infant, Newborn; D008099:Liver / Q000473:pathology*; D016015:Logistic Models; D008168:Lung / Q000002:abnormalities* / Q000000981:diagnostic imaging* / Q000473:pathology; D008171:Lung Diseases / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality / Q000628:therapy; D008176:Lung Volume Measurements; D008279:Magnetic Resonance Imaging; D008297:Male; D011247:Pregnancy; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016216:Ultrasonography, Prenatal