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

Adesola C. Akinkuotu, Stephanie M. Cruz, Paulette I. Abbas, Timothy C. Lee, Stephen E. Welty, Oluyinka O. Olutoye, Christopher I. Cassady, Amy R. Mehollin-Ray, Rodrigo Ruano, Michael A. Belfort, Darrell L. Cass

Research output: Contribution to journalArticle

35 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)44-48
Number of pages5
JournalJournal of Pediatric Surgery
Volume51
Issue number1
DOIs
StatePublished - Jan 1 2016
Externally publishedYes

Keywords

  • CDH
  • Fetal lung volumes
  • Prenatal predictors
  • Risk stratification

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health

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    Akinkuotu, A. C., Cruz, S. M., Abbas, P. I., Lee, T. C., Welty, S. E., Olutoye, O. O., Cassady, C. I., Mehollin-Ray, A. R., Ruano, R., Belfort, M. A., & Cass, D. L. (2016). Risk-stratification of severity for infants with CDH: Prenatal versus postnatal predictors of outcome. Journal of Pediatric Surgery, 51(1), 44-48. https://doi.org/10.1016/j.jpedsurg.2015.10.009