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

Keita Terui; Kouji Nagata; Masahiro Hayakawa; Hiroomi Okuyama; Shoichirou Amari; Akiko Yokoi; Kouji Masumoto; Naoto Urushihara; Tadaharu Okazaki; Noboru Inamura; Katsuaki Toyoshima; Keiichi Uchida; Taizo Furukawa; Manabu Okawada; Yasunori Sato; Noriaki Usui

doi:10.1055/s-0039-1698768

European Journal of Pediatric Surgery, Table of Contents

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

¹Department of Pediatric Surgery, Chiba University, Chiba, Japan

,

Kouji Nagata

²Department of Pediatric Surgery, Reproductive and Developmental Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

,

Masahiro Hayakawa

³Division of Neonatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Japan

,

Hiroomi Okuyama

⁴Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan

,

Shoichirou Amari

⁵Division of Neonatology, National Center for Child Health and Development, Setagaya-ku, Tokyo, Japan

,

Akiko Yokoi

⁶Department of Pediatric Surgery, Kobe Children's Hospital, Kobe, Japan

,

Kouji Masumoto

⁷Department of Pediatric Surgery, Tsukuba Daigaku, Tsukuba, Ibaraki, Japan

,

Naoto Urushihara

⁸Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan

,

Tadaharu Okazaki

⁹Department of Pediatric Surgery, Juntendo University Urayasu Hospital, Chiba, Japan

,

Noboru Inamura

¹⁰Department of Pediatrics, Kinki University, Higashiosaka, Osaka, Japan

,

Katsuaki Toyoshima

¹¹Departments of Neonatology, Kanagawa Childrens Medical Center, Yokohama, Kanagawa, Japan

,

Keiichi Uchida

¹²Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan

,

Taizo Furukawa

¹³Department of Pediatric Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan

,

Manabu Okawada

¹⁴Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan

,

Yasunori Sato

¹⁵Department of Preventive Medicine and Public Health, Keio University, Minato-ku, Tokyo, Japan

,

Noriaki Usui

¹⁶Department of Pediatric Surgery, Osaka Women's and Children's Hospital, Izumi, Japan

› Author Affiliations

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

Full Text

References

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