Prenatal Prediction of Delayed Abdominal Closure in Isolated Congenital Diaphragmatic Hernia Using Observed-to-Expected Lung-to-Head Ratio.

O/E LHR in isolated left-sided congenital diaphragmatic hernia predicts postnatal delayed abdominal wall closure with AUC 0.939 and an optimal cut-off of 34.1%.

• Why it matters: The prenatal severity marker O/E LHR is established, but its ability to forecast the specific postnatal need for delayed abdominal closure was unclear.
• What they did: In a retrospective cohort of 45 neonates with isolated left-sided CDH (2015–2026), ROC analysis and bootstrap-derived thresholds evaluated O/E LHR for DAC versus primary closure, with logistic regression including liver herniation adjustment.
• The result: O/E LHR remained independently associated with DAC after multivariate analysis (OR 0.821, 95% CI 0.668–0.939, p = 0.002), supporting prenatal risk stratification pending external validation.

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