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

J Pediatr Surg. 2016 Jan;51(1):44-8. doi: 10.1016/j.jpedsurg.2015.10.009. Epub 2015 Oct 22.


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.

Keywords: CDH; Fetal lung volumes; Prenatal predictors; Risk stratification.

Publication types

  • Comparative Study

MeSH terms

  • Decision Support Techniques*
  • Female
  • Hernias, Diaphragmatic, Congenital / diagnosis*
  • Hernias, Diaphragmatic, Congenital / mortality
  • Humans
  • Infant, Newborn
  • Predictive Value of Tests
  • Pregnancy
  • Prenatal Diagnosis*
  • Prognosis
  • Retrospective Studies
  • Risk Assessment
  • Severity of Illness Index*