A Nomogram Model for Prenatal Predicting Survival in Infants with Congenital Diaphragmatic Hernia

The study aimed to combine prenatal risk factors associated with early survival of patients with prenatally diagnosed congenital diaphragmatic hernia (CDH) into a predictive nomogram.We retrospectively analyzed 217 neonates with prenatally diagnosed CDH. The patients who underwent surgery in an earlier period comprised the training cohort (n = 158) for nomogram development, while those who underwent surgery subsequently constituted the validation cohort (n = 59) to verify the model's performance. The survival rate at discharge was regarded as the primary outcome. Multivariate Logistic analysis was performed, and a nomogram was developed using data from the training cohort. The performance of the nomogram was determined. We also evaluated the nomogram's performance in the independent validation cohorts.On multiple analyses, independent factors for early survival were O/E LHR, presence of liver herniation, and gestational age at diagnosis, which were all selected into the nomogram. The nomogram had good discrimination with an area under the receiver operator curve of 0.875 (95% confidence interval [CI]: 0.819-0.930). The nomogram was calibrated to predict survival in the best possible way compared with the actual results. Using the decision curve analysis, the nomogram was proved to be useful in clinical practice. In the validation cohort, the nomogram model was also found with good discrimination with an area under the receiver operator curve of 0.917 (95% CI: 0.847-0.986).The proposed nomogram incorporating prenatal risk factors offered an individualized predictive tool for early survival of patients with CDH, which will help guide prenatal counseling and perinatal management.