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Factors associated with lateral abdominal protrusion after congenital diaphragmatic hernia repair
Yuki Noguchi1, Daichi Sakai2, Ririko Takemura2
1Department of Pediatric Surgery, Osaka Women's and Children's Hospital, 840, Murodocho, Izumi, Osaka, 594-1101, Japan. noguchi@wch.opho.jp.
Purpose:
Lateral abdominal protrusion (LAP) is observed after congenital diaphragmatic hernia (CDH) repair. We developed an objective radiographic index and explored factors associated with LAP.
Methods:
Seventy-three patients who underwent neonatal CDH repair between 2013 and 2023 were retrospectively evaluated. The standardized LAP index (SLAPI) was developed in the 2013-2018 cohort and validated in the 2019-2023 cohort. Candidate factors available before LAP detection were examined using univariable logistic regression, followed by exploratory Firth logistic regression. Intraobserver reliability was assessed by repeated measurement.
Results:
Visually identified LAP occurred in 19 patients (26.0%) at a median age of 35 days. In the development cohort, the SLAPI area under the curve was 1.00 (95% confidence interval [CI], 1.00-1.00). At the prespecified cutoff of ≥ 1.0, sensitivity and specificity were 91.7% and 100% in the development cohort and 100% and 100% in the validation cohort, respectively. In the adjusted analysis, prenatal stomach herniation grade 2-3 (odds ratio [OR], 6.67; 95% CI, 1.62-32.63) and observed-to-expected lung area-to-head circumference ratio per 10-percentage-point increase (OR, 0.54; 95% CI, 0.24-0.96) were associated with LAP. Intraobserver reliability was good (intraclass correlation coefficient, 0.885).
Conclusion:
SLAPI objectively documented LAP after CDH repair. Its clinical and functional significance requires further study.