Prenatal risk stratification for isolated congenital diaphragmatic hernia: results of a Japanese multicenter study |
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Authors: | Usui Noriaki Kitano Yoshihiro Okuyama Hiroomi Saito Mari Masumoto Kouji Morikawa Nobuyuki Takayasu Hajime Nakamura Tomoo Hayashi Satoshi Kawataki Motoyoshi Ishikawa Hiroshi Nose Keisuke Inamura Noboru Sago Haruhiko |
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Institution: | a Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Osaka, Japanb Division of Surgery, National Center for Child Health and Development, Tokyo, Japand Division of Clinical Research, National Center for Child Health and Development, Tokyo, Japanf Department of Maternal-Fetal and Neonatal Medicine, National Center for Child Health and Development, Tokyo, Japanc Department of Pediatric Surgery, Hyogo College of Medicine, Hyogo, Japane Department of Pediatric Surgery, Kyushu University, Fukuoka, Japang Department of Perinatal Care, Kanagawa Children's Medical Center, Yokohama, Japanh Department of Pediatric Surgery, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japani Department of Pediatric Cardiology, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan |
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Abstract: | Background/PurposeThe aim of this study was to establish a prenatal prognostic classification system for risk-stratified management in fetuses with isolated congenital diaphragmatic hernia (CDH).MethodsA 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.ResultsPatients 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.ConclusionsOur 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. |
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Keywords: | Congenital diaphragmatic hernia Prenatal diagnosis Risk stratification Prognostic classification Multicenter study |
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