Keita Terui1, Kouji Nagata2, Masahiro Hayakawa3, Hiroomi Okuyama4, Shoichirou Amari5, Akiko Yokoi6, Kouji Masumoto7, Naoto Urushihara8, Tadaharu Okazaki9, Noboru Inamura10, Katsuaki Toyoshima11, Keiichi Uchida12, Taizo Furukawa13, Manabu Okawada14, Yasunori Sato15, Noriaki Usui16. 1. Department of Pediatric Surgery, Chiba University, Chiba, Japan. 2. Department of Pediatric Surgery, Reproductive and Developmental Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. 3. Division of Neonatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Japan. 4. Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan. 5. Division of Neonatology, National Center for Child Health and Development, Setagaya-ku, Tokyo, Japan. 6. Department of Pediatric Surgery, Kobe Children's Hospital, Kobe, Japan. 7. Department of Pediatric Surgery, Tsukuba Daigaku, Tsukuba, Ibaraki, Japan. 8. Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan. 9. Department of Pediatric Surgery, Juntendo University Urayasu Hospital, Chiba, Japan. 10. Department of Pediatrics, Kinki University, Higashiosaka, Osaka, Japan. 11. Departments of Neonatology, Kanagawa Childrens Medical Center, Yokohama, Kanagawa, Japan. 12. Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan. 13. Department of Pediatric Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan. 14. Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan. 15. Department of Preventive Medicine and Public Health, Keio University, Minato-ku, Tokyo, Japan. 16. Department of Pediatric Surgery, Osaka Women's and Children's Hospital, Izumi, Japan.
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. Georg Thieme Verlag KG Stuttgart · New York.
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. Georg Thieme Verlag KG Stuttgart · New York.