Risk-stratification of severity for infants with CDH: Prenatal versus postnatal predictors of outcome

Abstract Purpose The purpose of this study was to compare the predication accuracy of a newly described postnatally-based clinical prediction model to fetal imaging-based predictors of mortality for infants with CDH. Methods We performed a retrospective review of all CDH patients treated at a compre...

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Published in:Journal of pediatric surgery 2016, Vol.51 (1), p.44-48
Main Authors: Akinkuotu, Adesola C, Cruz, Stephanie M, Abbas, Paulette I, Lee, Timothy C, Welty, Stephen E, Olutoye, Oluyinka O, Cassady, Christopher I, Mehollin-Ray, Amy R, Ruano, Rodrigo, Belfort, Michael A, Cass, Darrell L
Format: Article
Language:English
Subjects:
CDH
Decision Support Techniques
Female
Fetal lung volumes
Hernias, Diaphragmatic, Congenital - diagnosis
Hernias, Diaphragmatic, Congenital - mortality
Humans
Infant, Newborn
Pediatrics
Predictive Value of Tests
Pregnancy
Prenatal Diagnosis
Prenatal predictors
Prognosis
Retrospective Studies
Risk Assessment
Risk stratification
Severity of Illness Index
Surgery
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Summary:Abstract Purpose The purpose of this study was to compare the predication accuracy of a newly described postnatally-based clinical prediction model to fetal imaging-based predictors of mortality for infants with CDH. Methods We performed a retrospective review of all CDH patients treated at a comprehensive fetal care center from January 2004 to January 2014. Prenatal data reviewed included lung-to-head ratio (LHR), observed/expected-total fetal lung volume (O/E-TFLV), and percent liver herniation (%LH). Based on the postnatal prediction model, neonates were categorized as low, intermediate, and high risk of death. The primary outcome was 6-month mortality. Results Of 176 CDH patients, 58 had a major cardiac anomaly, and 28 had a genetic anomaly. Patients with O/E-TFLV < 35% and %LH > 20% were at increased risk for mortality (44% and 36%, respectively). There was a significant difference in mortality between low, intermediate, and high-risk groups (4% vs. 22% vs. 51%; p < 0.001). On multivariate regression, the O/E-TFLV and postnatal-based mortality risk score were the two independent predictors of 6-month mortality. Conclusion The CDH Study Group postnatal predictive model provides good discrimination among three risk groups in our patient cohort. The prenatal MRI-based O/E-TFLV is the strongest prenatal predictor of 6-month mortality in infants with CDH and will help guide prenatal counseling and discussions regarding fetal intervention and perinatal management.
ISSN:0022-3468
1531-5037
DOI:10.1016/j.jpedsurg.2015.10.009