TY - JOUR
T1 - Prenatal risk stratification for isolated congenital diaphragmatic hernia
T2 - Results of a Japanese multicenter study
AU - Usui, Noriaki
AU - Kitano, Yoshihiro
AU - Okuyama, Hiroomi
AU - Saito, Mari
AU - Masumoto, Kouji
AU - Morikawa, Nobuyuki
AU - Takayasu, Hajime
AU - Nakamura, Tomoo
AU - Hayashi, Satoshi
AU - Kawataki, Motoyoshi
AU - Ishikawa, Hiroshi
AU - Nose, Keisuke
AU - Inamura, Noboru
AU - Sago, Haruhiko
N1 - Funding Information:
This work was supported by a grant from The Ministry of Health, Labour and Welfare of Japan (Health and Labour Sciences Research Grants for Clinical Research for New Medicine).
Copyright:
Copyright 2012 Elsevier B.V., All rights reserved.
PY - 2011/10
Y1 - 2011/10
N2 - 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.
AB - 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.
KW - Congenital diaphragmatic hernia
KW - Multicenter study
KW - Prenatal diagnosis
KW - Prognostic classification
KW - Risk stratification
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U2 - 10.1016/j.jpedsurg.2011.06.007
DO - 10.1016/j.jpedsurg.2011.06.007
M3 - Article
C2 - 22008320
AN - SCOPUS:80054759788
VL - 46
SP - 1873
EP - 1880
JO - Journal of Pediatric Surgery
JF - Journal of Pediatric Surgery
SN - 0022-3468
IS - 10
ER -