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

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Kazunori Masahata1, Noriaki Usui1, Yoshiyuki Shimizu2

  • 1Department of Pediatric Surgery, Osaka Women's and Children's Hospital, Izumi, Japan.

Journal of Pediatric Surgery
|December 23, 2019
PubMed

Insights

This study validated a prenatal risk stratification system for isolated congenital diaphragmatic hernia (CDH), showing significant differences in outcomes based on risk groups. The system aids in risk-adjusted management for fetuses with CDH.

Area of Science:

  • Fetal Medicine
  • Pediatric Surgery
  • Neonatology

Background:

  • Congenital diaphragmatic hernia (CDH) is a serious condition requiring accurate risk assessment.
  • Prenatal diagnosis and risk stratification are crucial for optimizing management strategies.

Purpose of the Study:

  • To evaluate a prenatal risk stratification system for isolated congenital diaphragmatic hernia (CDH).
  • To assess the system's utility in risk-adjusted management of fetuses with CDH.

Main Methods:

  • Retrospective single-center cohort study of 94 infants with isolated CDH.
  • Prenatal classification into four risk groups (A, B, C) based on liver position and lung-to-thorax ratio (L/T).
  • Analysis of survival and intact discharge rates across risk groups.

Main Results:

  • Group A (no liver-up, L/T >0.08) had 100% survival; subgroups A-1 (mild) and A-2 (severe) had 91.7% and 90.0% intact discharge, respectively.
  • Group B (liver-up or L/T <0.08) had 87.0% survival and 52.1% intact discharge.
  • Group C (liver-up and L/T <0.08) had 58.8% survival and 23.5% intact discharge.

Conclusions:

  • The prenatal risk stratification system effectively differentiates disease severity in isolated CDH.
  • The system demonstrates significant differences in postnatal status and clinical outcomes among risk groups.
  • This tool supports risk-adjusted management for fetuses diagnosed with CDH.
Abstract

Keywords:
Congenital diaphragmatic herniaPrenatal diagnosisPrognostic classificationRisk stratification

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