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Optimal timing of delivery for pregnancies with prenatally diagnosed congenital diaphragmatic hernia: a propensity-score analysis using the inverse probability of treatment weighting

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Abstract

Objective

To evaluate the optimal timing of neonates with prenatally diagnosed congenital diaphragmatic hernia (CDH).

Methods

Data from a retrospective cohort study conducted by the Japanese CDH Study Group between 2011 and 2018 were divided into two groups according to delivery timing: 36–37 and 38–41 weeks of gestation (wg). Death before 90 days as the primary outcome and the duration of hospitalization, oxygen therapy and tube feeding at discharge as the secondary outcomes were analyzed with generalized linear model applying inverse probability of treatment weighting method. We also performed layered analysis according to stomach position.

Result

Among 493 neonates with prenatally diagnosed, isolated and left CDH, 237 were born at 38–41wg. The duration of hospitalization was significantly shorter in those born at 38–41wg, especially among those with stomach malposition, and the other outcomes showed no difference.

Conclusions

Delivery at 38–41wg could be beneficial for those with high grade stomach position.

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Fig. 1: Distribution of cases.

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Acknowledgements

We thank all institutions that collected the data used for the present study.

Funding

The Health and Labor Sciences Research Grants for Research on Intractable Diseases from the Ministry of Health, Labor and Welfare of Japan.

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Authors and Affiliations

  1. Department of Obstetrics and gynecology, Osaka University Graduate School of Medicine, Osaka, Japan

    Yoko Kawanishi & Masayuki Endo

  2. Department of Children and Women’s Health, Osaka University Graduate School of Medicine, Osaka, Japan

    Masayuki Endo

  3. StemRIM Institute of Regeneration-Inducing Medicine, Division of Health Science, Graduate School of Medicine, Osaka University, Osaka, Japan

    Makoto Fujii & Tatsuo Masuda

  4. Department of Pediatric Surgery, Osaka Women’s and Children’s Hospital, Osaka, Japan

    Noriaki Usui

  5. Department of Pediatric Surgery, Kyushu University, Fukuoka, Japan

    Kouji Nagata & Tomoaki Taguchi

  6. Department of Pediatric Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan

    Keita Terui

  7. Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Japan

    Masahiro Hayakawa

  8. Division of Neonatology, National Center for Child Health and Development, Tokyo, Japan

    Shoichiro Amari

  9. Department of Pediatric Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan

    Kouji Masumoto

  10. Department of Pediatric Surgery, Juntendo University Urayasu Hospital, Chiba, Japan

    Tadaharu Okazaki

  11. Department of Pediatrics, Faculty of Medicine, Kinki University, Osaka, Japan

    Noboru Inamura

  12. Department of Pediatric Surgery, Shizuoka Children’s Hospital, Shizuoka, Japan

    Naoto Urushihara

  13. Departments of Neonatology, Kanagawa Children’s Medical Center, Yokohama, Japan

    Katsuaki Toyoshima

  14. Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Japan

    Keiichi Uchida

  15. Department of Pediatric Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan

    Taizo Furukawa

  16. Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan

    Manabu Okawada

  17. Departments of Pediatric Surgery, Kobe Children’s Medical Center, Kobe, Japan

    Akiko Yokoi

  18. Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Osaka, Japan

    Hiroomi Okuyama

Authors
  1. Yoko Kawanishi
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  2. Masayuki Endo
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  3. Makoto Fujii
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  4. Tatsuo Masuda
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  5. Noriaki Usui
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  6. Kouji Nagata
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  7. Keita Terui
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  8. Masahiro Hayakawa
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  9. Shoichiro Amari
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  10. Kouji Masumoto
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  11. Tadaharu Okazaki
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  12. Noboru Inamura
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  13. Naoto Urushihara
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  14. Katsuaki Toyoshima
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  15. Keiichi Uchida
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  16. Taizo Furukawa
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  17. Manabu Okawada
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  18. Akiko Yokoi
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  19. Tomoaki Taguchi
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  20. Hiroomi Okuyama
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Contributions

YK mainly contributed to the design of the work, data analysis and interpretation of the work and drafting. EM contributed to the design of the work and interpretation of data for work. MF and TM supervised the analysis. NU, KN, KT, MH, SA, KM, TO, NI, NU, KT, KU, TF, MO, AY, and TT contributed to data collection, making revisions for the draft and interpretation of the work. HO contributed to data collection, supported the study design, revised the draft, and approved the final version to be published.

Corresponding author

Correspondence to Hiroomi Okuyama.

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The authors declare no competing interests.

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Kawanishi, Y., Endo, M., Fujii, M. et al. Optimal timing of delivery for pregnancies with prenatally diagnosed congenital diaphragmatic hernia: a propensity-score analysis using the inverse probability of treatment weighting. J Perinatol 41, 1893–1900 (2021). https://doi.org/10.1038/s41372-021-01118-2

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