Eur J Pediatr Surg. 2019 Oct 10. doi: 10.1055/s-0039-1698768. [Epub ahead of print]
Novel Risk Score for Fetuses with Congenital Diaphragmatic Hernia Based on Ultrasound Findings.
1Department of Pediatric Surgery, Chiba University, Chiba, Japan.2Department of Pediatric Surgery, Reproductive and Developmental Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.3Division of Neonatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Japan.4Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.5Division of Neonatology, National Center for Child Health and Development, Setagaya-ku, Tokyo, Japan.6Department of Pediatric Surgery, Kobe Children’s Hospital, Kobe, Japan.7Department of Pediatric Surgery, Tsukuba Daigaku, Tsukuba, Ibaraki, Japan.8Department of Pediatric Surgery, Shizuoka Children’s Hospital, Shizuoka, Japan.9Department of Pediatric Surgery, Juntendo University Urayasu Hospital, Chiba, Japan.10Department of Pediatrics, Kinki University, Higashiosaka, Osaka, Japan.11Departments of Neonatology, Kanagawa Childrens Medical Center, Yokohama, Kanagawa, Japan.12Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan.13Department of Pediatric Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.14Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan.15Department of Preventive Medicine and Public Health, Keio University, Minato-ku, Tokyo, Japan.16Department of Pediatric Surgery, Osaka Women’s and Children’s Hospital, Izumi, Japan.
We aimed to establish and validate a risk score for fetuses with congenital diaphragmatic hernia (CDH) using only prenatal ultrasound findings.
MATERIAL AND METHODS:
Derivation (2011-2016, n = 350) and validation (2006-2010, n = 270) cohorts were obtained from a Japanese CDH study group database. Using a logistic regression analysis, we created a prediction model and weighted scoring system from the derivation dataset and calculated the odds ratio of an unsatisfactory prognosis (death within 90 days of life or hospitalization duration exceeding 180 days). Five adverse prognostic factors obtained using prenatal ultrasound, including an observed/expected lung area-to-head circumference ratio (o/eLHR) <25%, liver herniation occupying more than one-third of the thoracic space, thoracic stomach, right-side CDH, and severe malformations, were used as predictors. The obtained model was validated using the validation cohort.
The unsatisfactory prognosis prediction model was obtained based on the adjusted odds ratios. The C statistics of the model were 0.83 and 0.80 in the derivation and validation datasets, respectively. The five variables were weighted proportionally to their adjusted odds ratios for an unsatisfactory prognosis (o/eLHR <25%, 1 point; liver herniation occupying more than one-third of the thoracic space, 1 point; thoracic stomach, 1 point; right-side CDH, 2 points; and severe malformations, 3 points). Unsatisfactory prognosis rates for the low- (0-2 points), intermediate- (3-5 points), and high-risk (6-8 points) groups were 17, 46, and 100%, respectively (p < 0.001), in the validation cohort.
Our simple risk score effectively predicted the prognosis of fetuses with CDH.
Georg Thieme Verlag KG Stuttgart · New York.PMID: 31600805 DOI: 10.1055/s-0039-1698768