Clinical outcomes and protocol for the management of isolated congenital diaphragmatic hernia based on our prenatal risk stratification system

Kazunori Masahata; Noriaki Usui; Yoshiyuki Shimizu; Muneyuki Takeuchi; Jun Sasahara; Narutaka Mochizuki; Kazuya Tachibana; Takatoshi Abe; Taku Yamamichi; Hideki Soh

doi:10.1016/j.jpedsurg.2019.10.020

Clinical outcomes and protocol for the management of isolated congenital diaphragmatic hernia based on our prenatal risk stratification system

J Pediatr Surg. 2020 Aug;55(8):1528-1534. doi: 10.1016/j.jpedsurg.2019.10.020. Epub 2019 Nov 28.

Authors

Affiliations

¹ Department of Pediatric Surgery, Osaka Women's and Children's Hospital, Izumi, Japan. Electronic address: masahata@wch.opho.jp.
² Department of Pediatric Surgery, Osaka Women's and Children's Hospital, Izumi, Japan.
³ Department of Intensive Care Medicine, Osaka Women's and Children's Hospital, Izumi, Japan.
⁴ Department of Obstetrics, Osaka Women's and Children's Hospital, Izumi, Japan.
⁵ Department of Neonatology, Osaka Women's and Children's Hospital, Izumi, Japan.
⁶ Department of Anesthesiology, Osaka Women's and Children's Hospital, Izumi, Japan.

PMID: 31864663
DOI: 10.1016/j.jpedsurg.2019.10.020

Abstract

Background/purpose: The aim of this study was to evaluate our prenatal risk stratification system for risk-adjusted management in fetuses with isolated congenital diaphragmatic hernia (CDH).

Methods: Ninety-four infants prenatally diagnosed with isolated CDH treated between 1998 and 2017 at our institution were included in this retrospective single-center cohort study.

Results: The patients were prenatally classified into four risk groups: Group A (n = 54), which consisted of infants with neither liver-up nor a contralateral lung-to-thorax transverse area (L/T) ratio <0.08. The infants in group A were divided into two subgroups: Group A-1 (n = 24) consisted of mild conditions; and Group A-2 (n = 30) consisted of severe conditions; Group B (n = 23), which consisted of infants with either liver-up or L/T ratio <0.08; and Group C (n = 17), which consisted of infants with both liver-up and L/T ratio <0.08. The rates of survival to discharge in Groups A-1, A-2, B, and C were 100.0%, 100.0%, 87.0%, and 58.8%, respectively. The rates of intact discharge were 91.7%, 90.0%, 52.1%, and 23.5%, respectively.

Conclusions: Our prenatal risk stratification system demonstrated a significant difference in the severity of postnatal status and clinical outcomes between the groups.

Study type: Case Series, Retrospective Review.

Levels of evidence: LEVEL IV.

Keywords: Congenital diaphragmatic hernia; Prenatal diagnosis; Prognostic classification; Risk stratification.

MeSH terms

Female
Hernias, Diaphragmatic, Congenital* / diagnosis
Hernias, Diaphragmatic, Congenital* / epidemiology
Hernias, Diaphragmatic, Congenital* / surgery
Humans
Infant
Infant, Newborn
Pregnancy
Prenatal Diagnosis
Retrospective Studies
Risk Assessment
Treatment Outcome