TY - JOUR
T1 - Risk-stratification of severity for infants with CDH
T2 - Prenatal versus postnatal predictors of outcome
AU - Akinkuotu, Adesola C.
AU - Cruz, Stephanie M.
AU - Abbas, Paulette I.
AU - Lee, Timothy C.
AU - Welty, Stephen E.
AU - Olutoye, Oluyinka O.
AU - Cassady, Christopher I.
AU - Mehollin-Ray, Amy R.
AU - Ruano, Rodrigo
AU - Belfort, Michael A.
AU - Cass, Darrell L.
N1 - Publisher Copyright:
© 2016 Elsevier Inc.
PY - 2016/1/1
Y1 - 2016/1/1
N2 - 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.
AB - 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.
KW - CDH
KW - Fetal lung volumes
KW - Prenatal predictors
KW - Risk stratification
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U2 - 10.1016/j.jpedsurg.2015.10.009
DO - 10.1016/j.jpedsurg.2015.10.009
M3 - Article
C2 - 26563530
AN - SCOPUS:84952948462
SN - 0022-3468
VL - 51
SP - 44
EP - 48
JO - Journal of pediatric surgery
JF - Journal of pediatric surgery
IS - 1
ER -