Link: http://www.ncbi.nlm.nih.gov/pubmed/26537560

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Prenat Diagn. 2015 Nov 4. doi: 10.1002/pd.4721. [Epub ahead of print]
Prenatal and Postnatal Markers of Severity in Congenital Diaphragmatic Hernia have Similar Prognostic Ability.
Werner NL1, Coughlin M1, Kunisaki SM1, Hirschl R1, Ladino-Torres M2, Berman D3, Kreutzman J1, Mychaliska GB1.
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Abstract
OBJECTIVES:
The purpose of this study was to compare prenatal versus postnatal markers of congenital diaphragmatic hernia (CDH) severity at a single fetal-care center.

METHODS:
A retrospective study was performed of patients having a complete prenatal evaluation and surgical repair (n=55). Observed-to-expected lung-to-head ratio (o/eLHR), observed-to-expected total lung volume (o/eTLV), liver position (LP), a predictive dependent variable from logistic regression of o/eLHR and liver position (o/eLHR + LP), and diaphragmatic defect size per the CDH Study Group A-D classification were plotted into receiver operating characteristics (ROC) curves. Survival and need for extracorporeal membrane oxygenation (ECMO) were primary outcomes.

RESULTS:
Survival was 69% and ECMO utilization 56%. Distribution was 80% left-sided defects. In the survival ROC curve, the area under the curve (AUC) for o/eLHR was 0.73, o/eTLV 0.74, LP 0.73, o/eLHR + LP 0.78, and defect size 0.84 (p=0.23). The ROC curve for ECMO support showed o/eLHR had an AUC of 0.82, o/eTLV 0.89, LP 0.79, o/eLHR + LP 0.87, and defect size 0.90 (p=0.19). The AUCs were similar when only left-sided CDH was analyzed.

CONCLUSIONS:
These data suggest prenatal evaluation was equivalent to the postnatal diaphragmatic defect classification for predicting survival and need for ECMO in CDH patients.

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