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Eur J Pediatr Surg 2020; 30(01): 051-058
DOI: 10.1055/s-0039-1698768
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Novel Risk Score for Fetuses with Congenital Diaphragmatic Hernia Based on Ultrasound Findings

Keita Terui
1   Department of Pediatric Surgery, Chiba University, Chiba, Japan
,
Kouji Nagata
2   Department of Pediatric Surgery, Reproductive and Developmental Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
,
Masahiro Hayakawa
3   Division of Neonatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Japan
,
Hiroomi Okuyama
4   Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
,
Shoichirou Amari
5   Division of Neonatology, National Center for Child Health and Development, Setagaya-ku, Tokyo, Japan
,
Akiko Yokoi
6   Department of Pediatric Surgery, Kobe Children's Hospital, Kobe, Japan
,
Kouji Masumoto
7   Department of Pediatric Surgery, Tsukuba Daigaku, Tsukuba, Ibaraki, Japan
,
Naoto Urushihara
8   Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan
,
Tadaharu Okazaki
9   Department of Pediatric Surgery, Juntendo University Urayasu Hospital, Chiba, Japan
,
Noboru Inamura
10   Department of Pediatrics, Kinki University, Higashiosaka, Osaka, Japan
,
Katsuaki Toyoshima
11   Departments of Neonatology, Kanagawa Childrens Medical Center, Yokohama, Kanagawa, Japan
,
Keiichi Uchida
12   Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
,
Taizo Furukawa
13   Department of Pediatric Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
,
Manabu Okawada
14   Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan
,
Yasunori Sato
15   Department of Preventive Medicine and Public Health, Keio University, Minato-ku, Tokyo, Japan
,
Noriaki Usui
16   Department of Pediatric Surgery, Osaka Women's and Children's Hospital, Izumi, Japan
› Author Affiliations Funding This study was funded by the Ministry of Health, Labor, and Welfare of Japan (Grant/Award Number: “H24-Nanchi-Ippan-034”).
Further Information

Publication History

07 May 2019

02 September 2019

Publication Date:
10 October 2019 (online)

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Abstract

Introduction 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.

Results 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.

Conclusion Our simple risk score effectively predicted the prognosis of fetuses with CDH.

Keywords

congenital diaphragmatic hernia - fetus - prognosis - morbidity
 

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