Population-Based Validation of a Clinical Prediction Model for Congenital Diaphragmatic Hernias

Bent, Daniel P.; Nelson, Jason; Kent, David M.; Jen, Howard C.

doi:10.1016/j.jpeds.2018.05.027

Cited by 28 publications

(27 citation statements)

References 31 publications

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“…Several studies have created postnatal mortality-predictive models. The Congenital Diaphragmatic Hernia Study Group model is based on birth weight, 5 min Apgar, pulmonary hypertension, major cardiac defects and chromosomal anomalies, and the Wilford Hall/Santa Rosa equation is based on blood gas measurements 19–21. To date, no studies have examined tidal volumes (Vt) of spontaneous breaths in the first minutes after birth as a predictive factor for adverse outcomes.…”

Section: Introductionmentioning

confidence: 99%

Tidal volumes at birth as predictor for adverse outcome in congenital diaphragmatic hernia

Mank

Carrasco

Thió

et al. 2019

Arch Dis Child Fetal Neonatal Ed

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ObjectiveTo assess the predictive value of tidal volume (Vt) of spontaneous breaths at birth in infants with congenital diaphragmatic hernia (CDH).DesignProspective study.SettingTertiary neonatal intensive care unit.PatientsThirty infants with antenatally diagnosed CDH born at Hospital Sant Joan de Déu in Barcelona from September 2013 to September 2015.InterventionsSpontaneous breaths and inflations given in the first 10 min after intubation at birth were recorded using respiratory function monitor. Only expired Vt of uninterrupted spontaneous breaths was included for analysis. Receiver operating characteristics (ROC) analysis was performed and the area under the curve (AUC) was estimated to assess the predictive accuracy of Vt.Main outcome measuresMortality before hospital discharge and chronic lung disease (CLD) at day 28 of life.ResultsThere were 1.233 uninterrupted spontaneous breaths measured, and the overall mean Vt was 2.8±2.1 mL/kg. A lower Vt was found in infants who died (n=14) compared with survivors (n=16) (1.7±1.6 vs 3.7±2.1 mL/kg; p=0.008). Vt was lower in infants who died during admission or had CLD (n=20) compared with survivors without CLD (n=10) (2.0±1.7 vs 4.3±2.2 mL/kg; p=0.004). ROC analysis showed that Vt ≤2.2 mL/kg predicted mortality with 79% sensitivity and 81% specificity (AUC=0.77, p=0.013). Vt ≤3.4 mL/kg was a good predictor of death or CLD (AUC=0.80, p=0.008) with 85% sensitivity and 70% specificity.ConclusionVt of spontaneous breaths measured immediately after birth is associated with mortality and CLD. Vt seems to be a reliable predictor but is not an independent predictor after adjustment for observed/expected lung to head ratio and liver position.

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Section: Introductionmentioning

confidence: 99%

Tidal volumes at birth as predictor for adverse outcome in congenital diaphragmatic hernia

Mank

Carrasco

Thió

et al. 2019

Arch Dis Child Fetal Neonatal Ed

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“…In this study, we externally validated the CDHSG rule in the European population. We found that the rule had fair discrimination, but also room for optimization, compared with the internal validation of Brindle et al 15 Bent et al 16 also validated the rule in a large group of patients with CDH born in California and found an underestimation of mortality in the patients with a score of 1. We did not find this in our population.…”

Section: Discussionmentioning

confidence: 59%

“…Validation of the prediction rule revealed reasonable discrimination between groups. 15,16 This postnatal model has been favorably compared with prenatal predictors. 17 However, there is potential value in combining postand prenatal risk factors within a single prediction model.…”

Section: What This Study Adds: We Validated the Congenital Diaphragmaticmentioning

confidence: 99%

Validation of a Prediction Rule for Mortality in Congenital Diaphragmatic Hernia

Otter¹,

Erdem²,

Rosmalen

et al. 2020

Pediatrics

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BACKGROUND: Congenital diaphragmatic hernia (CDH) is a rare congenital anomaly with a mortality of ∼27%. The Congenital Diaphragmatic Hernia Study Group (CDHSG) developed a simple postnatal clinical prediction rule to predict mortality in newborns with CDH. Our aim for this study is to externally validate the CDHSG rule in the European population and to improve its prediction of mortality by adding prenatal variables.

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“…This CDH scoring equation includes five predictors: 5 min Apgar, birth weight, PH, chromosomal anomalies and major cardiac defects 44. External validation has confirmed good performance and discrimination among the three groups 45…”

Section: Delivery Room Management: Novel Conceptsmentioning

confidence: 94%

Perinatal stabilisation of infants born with congenital diaphragmatic hernia: a review of current concepts

Horn-Oudshoorn

Knol

Pas

et al. 2020

Arch Dis Child Fetal Neonatal Ed

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Congenital diaphragmatic hernia (CDH) is associated with high mortality rates and significant pulmonary morbidity, mainly due to disrupted lung development related to herniation of abdominal organs into the chest. Pulmonary hypertension is a major contributor to both mortality and morbidity, however, treatment modalities are limited. Novel prenatal and postnatal interventions, such as fetal surgery and medical treatments, are currently under investigation. Until now, the perinatal stabilisation period immediately after birth has been relatively overlooked, although optimising support in these early stages may be vital in improving outcomes. Moreover, physiological parameters obtained from the perinatal stabilisation period could serve as early predictors of adverse outcomes, thereby facilitating both prevention and early treatment of these conditions. In this review, we focus on the perinatal stabilisation period by discussing the current delivery room guidelines in infants born with CDH, the physiological changes occurring during the fetal-to-neonatal transition in CDH, novel delivery room strategies and early predictors of adverse outcomes. The combination of improvements in the perinatal stabilisation period and early prediction of adverse outcomes may mitigate the need for specific postnatal management strategies.copyright.on July 4, 2020 by guest. Protected by

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Population-Based Validation of a Clinical Prediction Model for Congenital Diaphragmatic Hernias

Abstract: We successfully validated the CDHSG prediction model using an external population-based cohort of newborns with CDH in California. This cohort may be used to investigate hospital volume-outcome relationships and guide policy development.

Cited by 28 publications

References 31 publications

Tidal volumes at birth as predictor for adverse outcome in congenital diaphragmatic hernia

Tidal volumes at birth as predictor for adverse outcome in congenital diaphragmatic hernia

Validation of a Prediction Rule for Mortality in Congenital Diaphragmatic Hernia

Perinatal stabilisation of infants born with congenital diaphragmatic hernia: a review of current concepts

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