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Prediction of outcome in infants with congenital diaphragmatic hernia or severe diaphragmatic eventration
Chih-Ta Yao1, Jieh-Neng Wang, Chyi-Her Lin
1Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Insights
Prognosis for congenital diaphragmatic hernia (CDH) and severe congenital diaphragmatic eventration (SDE) can be predicted using Apgar scores and blood gas levels. The Nakada pulmonary artery index shows promise as a prognostic marker for these conditions.
Area of Science:
- Pediatric Surgery
- Neonatology
- Cardiovascular Imaging
Background:
- Congenital diaphragmatic hernia (CDH) and severe congenital diaphragmatic eventration (SDE) are associated with high mortality rates.
- Identifying reliable prognostic factors is crucial for managing these complex neonatal conditions.
Purpose of the Study:
- To identify clinical prognostic factors for CDH and SDE.
- To evaluate the correlation between pulmonary artery (PA) size/area and clinical outcomes in these patients.
Main Methods:
- Retrospective analysis of 26 infants (20 CDH, 6 SDE) over 12 years.
- Comparison of prenatal history, clinical data, blood gas analysis, and echocardiography between survivors and non-survivors.
- Calculation of McGoon and Nakada indices for PA size.
Main Results:
- Survivors had significantly higher Apgar scores, pH, and lower oxygen indices and PaCO2.
- The Nakada PA index was significantly higher in survivors (121.07 +/- 27.08) compared to non-survivors (93.07 +/- 32.02).
- The McGoon index showed a trend towards significance but did not reach statistical significance.
Conclusions:
- Apgar scores, preductal PaCO2, oxygen index, and pH levels are significant predictors of prognosis in infants with CDH and SDE.
- The Nakada PA index may serve as a valuable prognostic marker for assessing outcomes in CDH and SDE patients.
Abstract:
Congenital diaphragmatic hernia (CDH) and severe congenital diaphragmatic eventration (SDE) still have high mortality. Our aims were to identify clinical prognostic factors for CDH and SDE, and to determine whether the size or area of the proximal bilateral pulmonary arteries (PA) correlate with the clinical outcome. We retrospectively analyzed medical charts of 26 patients--20 with CDH and 6 with SDE, but no obvious other associated anomalies--admitted over a 12-year period. We compared prenatal history, clinical manifestations, blood gas, and echocardiography before surgery in the survivors and the non-survivors. Ten patients (8 CDH, 2 SDE) died 2 to 16 days after birth, including 2 patients without surgery due to progressive hypoxemia. The survivors had significantly higher 1- and 5-min Apgar scores, higher the worst preductal arterial blood gas pH levels, lower oxygen indices, and lower PaCO2 (P < 0.05). The McGoon index of PA size measured by echocardiography was higher in survivors, but not statistically significant. Nakada PA index results, however, were statistically significant (93.07 +/- 32.02 vs. 121.07 +/- 27.08, P < 0.05) In conclusion, Apgar scores, preductal PaCO2, oxygen index, and pH level can predict prognosis in infants with CDH and SDE. The Nakada PA index, however, might be a useful prognostic marker for patients with CDH and SDE.
