Prenatal Prediction of Delayed Abdominal Closure in Isolated Congenital Diaphragmatic Hernia Using Observed-to-Expected Lung-to-Head Ratio.
- 1Hospital Universitario La Paz
Abstract
Objective: O/E LHR is a well-established prenatal severity marker in congenital diaphragmatic hernia (CDH), but its capacity to predict the postnatal need for delayed abdominal wall closure (DAC) remains undefined. We aimed to determine its predictive capacity. Method: Retrospective analysis of neonates with isolated left-sided CDH (2015-2026), comparing primary closure with DAC. Discriminative capacity was assessed by ROC analysis and the optimal cut-off was determined by bootstrap-aggregated approach. Logistic regression estimated univariate and liver herniation adjusted multivariate odds ratios (OR). Result: 45 neonates were included, 28 underwent primary closure and 17 required DAC. DAC was associated with lower gestational age, higher rates of liver herniation, greater ECMO requirement, and higher mortality than primary closure (all p < 0.01). O/E LHR showed excellent discriminative ability for DAC (AUC 0.939), with an optimal cut-off of 34.1% (sensitivity 82.35%, specificity 82.14%, positive predictive value 73.68%, negative predictive value 88.46%). O/E LHR was independently associated with DAC after multivariate analysis (OR 0.821, 95% CI 0.668-0.939, p = 0.002). Conclusions: O/E LHR was independently associated with DAC risk beyond liver herniation. These preliminary findings suggest a potential role for O/E LHR in prenatal risk stratification for DAC, pending external validation.
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BibTeX
@misc{moratillalapena2026prenatal,
title = {{Prenatal Prediction of Delayed Abdominal Closure in Isolated Congenital Diaphragmatic Hernia Using Observed-to-Expected Lung-to-Head Ratio.}},
author = {L. Moratilla-Lapena and J. L. Encinas and E. Antolin and A. Sanchez Torres and F. Hernandez Oliveros},
howpublished = {medRxiv},
year = {2026},
month = nov,
doi = {10.64898/2026.11.04.26367256},
url = {https://www.medrxiv.org/content/10.64898/2026.11.04.26367256v1},
note = {CC BY-NC-ND},
}
RIS
TY - UNPB
TI - Prenatal Prediction of Delayed Abdominal Closure in Isolated Congenital Diaphragmatic Hernia Using Observed-to-Expected Lung-to-Head Ratio.
AU - L. Moratilla-Lapena
AU - J. L. Encinas
AU - E. Antolin
AU - A. Sanchez Torres
AU - F. Hernandez Oliveros
PY - 2026
DA - 2026/11/04
PB - medRxiv
DO - 10.64898/2026.11.04.26367256
UR - https://www.medrxiv.org/content/10.64898/2026.11.04.26367256v1
AB - Objective: O/E LHR is a well-established prenatal severity marker in congenital diaphragmatic hernia (CDH), but its capacity to predict the postnatal need for delayed abdominal wall closure (DAC) remains undefined. We aimed to determine its predictive capacity. Method: Retrospective analysis of neonates with isolated left-sided CDH (2015-2026), comparing primary closure with DAC. Discriminative capacity was assessed by ROC analysis and the optimal cut-off was determined by bootstrap-aggregated approach. Logistic regression estimated univariate and liver herniation adjusted multivariate odds ratios (OR). Result: 45 neonates were included, 28 underwent primary closure and 17 required DAC. DAC was associated with lower gestational age, higher rates of liver herniation, greater ECMO requirement, and higher mortality than primary closure (all p < 0.01). O/E LHR showed excellent discriminative ability for DAC (AUC 0.939), with an optimal cut-off of 34.1% (sensitivity 82.35%, specificity 82.14%, positive predictive value 73.68%, negative predictive value 88.46%). O/E LHR was independently associated with DAC after multivariate analysis (OR 0.821, 95% CI 0.668-0.939, p = 0.002). Conclusions: O/E LHR was independently associated with DAC risk beyond liver herniation. These preliminary findings suggest a potential role for O/E LHR in prenatal risk stratification for DAC, pending external validation.
ER -