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Mortality prediction in infants with congenital diaphragmatic hernia: potential criteria for ECMO
Insights
Predicting infant mortality from congenital diaphragmatic hernia is crucial. An oxygenation index or ventilation index can accurately predict a 94% mortality rate in infants with this condition.
Area of Science:
- Pediatric Critical Care Medicine
- Neonatology
- Respiratory Physiology
Background:
- Congenital diaphragmatic hernia (CDH) survival rates in intensive care have remained stagnant.
- Emerging therapies necessitate improved methods for predicting CDH infant outcomes.
- Accurate prognostication is vital for guiding treatment decisions in neonates with CDH.
Purpose of the Study:
- To identify reliable predictors of mortality in infants with congenital diaphragmatic hernia.
- To evaluate the efficacy of specific indices in forecasting survival or death.
Main Methods:
- Retrospective review of CDH infant cases admitted to the Royal Children's Hospital Intensive Care Unit (1980-1989).
- Analysis of blood gas data, ventilatory parameters, and patient outcomes.
- Receiver operating curve (ROC) analysis to determine the optimal predictive index for mortality.
Main Results:
- An oxygenation index (MAP x FiO2/PaO2) greater than 0.3 predicted 94% mortality.
- A ventilation index (PIP x RR x CO2/1000) greater than 70 also predicted 94% mortality.
- These indices demonstrated high specificity (96%) and sensitivity (82%) for predicting mortality.
Conclusions:
- The oxygenation index and ventilation index are highly effective predictors of mortality in infants with congenital diaphragmatic hernia.
- These indices can aid clinicians in assessing prognosis and managing critically ill neonates with CDH.
- Implementing these predictive tools may inform therapeutic strategies and resource allocation for CDH patients.
Abstract:
Over the last ten years the survival of infants born with congenital diaphragmatic hernia who reach the Intensive Care Unit of the Royal Children's Hospital, Melbourne has been constant at 56 +/- 6%. Experimental therapies such as extracorporeal membrane oxygenation, high-frequency oscillation and lung transplantation are now being considered as therapeutic options, and as such the ability to predict survival or death of these infants is increasingly important. The records of all infants with congenital diaphragmatic hernia admitted to the Intensive Care Unit between 1 January 1980 and 30 April 1989 were reviewed; blood gas, ventilatory details, and outcome information was obtained. Receiver operating curve analysis was used to determine the best predictor of death. An oxygenation index (MAP x FiO2/PaO2) > 0.3 or ventilation index (PIP x RR x CO2/1000) > 70 predicted a 94% mortality with a specificity of 96% and a sensitivity of 82%.