Standardized prenatal assessment of risk-stratification for fetuses with congenital diaphragmatic hernia.
Congenital diaphragmatic hernia (CDH) occurs in approximately 1 in 2,500 live births and accounts for about 8% of all congenital anomalies. Among the patients with isolated CDH, morbidity and mortality depend predominantly on the severity of pulmonary hypoplasia and pulmonary arterial hypertension. Survival rates in neonates with isolated CDH have improved due to advances in neonatal respiratory management. Improvements in prenatal imaging, earlier prenatal diagnosis, and protocoled perinatal care have led to better patient selection for perinatal intervention including fetal tracheal occlusion and early ECMO initiation. The present NAFTNet study aims to standardize all these measurements in different centers in the United States that are part of this group, in order to better classify the fetuses according to prognosis. After standardizing the methods, a reproducibility study will be performed and, then, further evaluation will be performed to analyze the accuracy of these prenatal predictors. In order to evaluate those objectives, we aim to perform a retrospective multicenter NAFTNet study. The present study will contribute not only for the standardization and evaluation of the prenatal methods in different NAFTNet centers, but also to initiate a discussion about the standardization of the postnatal management for a future prospective study, before selecting candidates for fetal endoscopic tracheal occlusion.