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Birth weight and McGoon Index predict mortality in newborn infants with congenital diaphragmatic hernia
Germana Casaccia1, Francesco Crescenzi, Andrea Dotta
1Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital-IRCCS, 00165 Rome, Italy. casaccia@opbg.net
Insights
Birth weight and modified McGoon Index (MGI) are early predictors of mortality in newborns with congenital diaphragmatic hernia (CDH). Combining these factors offers a reliable method for assessing severity and comparing treatment outcomes.
Area of Science:
- Pediatric Surgery
- Neonatology
- Medical Statistics
Background:
- Congenital diaphragmatic hernia (CDH) continues to have high mortality rates despite advancements in clinical management.
- Accurate early prediction of mortality risk is crucial for evaluating treatment strategies and center performance.
- Existing predictors include birth weight (BW), Apgar score, and the modified McGoon Index (MGI).
Purpose of the Study:
- To assess the relationship between early detectable variables and survival in newborns with CDH.
- To evaluate newborns intubated at birth and managed with gentle ventilation and delayed surgery.
Main Methods:
- Retrospective review of medical records for high-risk CDH patients (January 2002-September 2004).
- Data collected included prenatal diagnosis, gestational age, BW, sex, hernia side, and MGI.
- Univariate and logistic regression analyses were used to identify predictors of mortality, with BW and MGI dichotomized based on ROC curve analysis.
Main Results:
- Thirty-four newborns with CDH were studied.
- Birth weight (BW) and MGI were significantly associated with mortality (P < .05).
- Optimal cutoffs were 2755g for BW and 1.25 for MGI; the combination of low BW and low MGI predicted 80% mortality.
Conclusions:
- Birth weight and MGI, individually and combined, are significant predictors of mortality in CDH.
- These variables serve as valid early severity scores, unaffected by subsequent care, enabling objective comparison of treatment centers and strategies.
Background:
Despite improvements in clinical management, mortality of congenital diaphragmatic hernia (CDH) remains high. Early prediction of mortality risk helps in comparing strategies and/or performances of different centers. Birth weight (BW), Apgar Score at 5 minutes, and modified McGoon Index (MGI) calculated by the ratio between the diameters of pulmonary arteries and the descending aorta have been used to determine mortality of CDH.
Aim:
The purpose of this study is to evaluate the relationship between early detectable variables and survival in newborns with CDH intubated at birth, managed with "gentle" ventilation and delayed surgery.
Methods:
All medical records of patients affected by high-risk CDH and treated with a standardized protocol at Bambino Gesù Children's Hospital, Rome, Italy, between January 2002 and September 2004 were reviewed. Prenatal diagnosis, gestational age, BW, sex, side of hernia, and MGI were recorded on admission. The relationship with mortality of each variable was evaluated by univariate analysis. Subsequently, a predictive model of mortality was developed using a logistic regression: the explanatory variables, BW, and MGI were dichotomized in high (HBW and HMGI) and low (LBW and LMGI) according to the best cutoff found with receiver-operating characteristic curves.
Results:
Thirty-four newborns with CDH, treated with a standardized protocol, were studied. The main characteristics of the 34 patients were BW, 2886 g (1500-3620 g); gestational age, 37.7 weeks (32-42 weeks); male/female, 22/12; right/left, 8/26; prenatal diagnosis, 29; MGI, 1.31 (0.9-1.85). Only BW and MGI were significantly (P < .05) associated with mortality at the univariate analysis. The best cutoff values were 2755 g for BW (sensitivity, 70%; specificity, 74%) and 1.25 for MGI (sensitivity, 73%; specificity, 78%). Using these limits, BW and MGI resulted independently associated with mortality in the multivariate analysis. Using the 4 possible combinations, the LBW associated with the LMGI presented the highest prediction of mortality (80%).
Conclusions:
Birth weight and MGI, variously combined, were predictive of mortality. Because they are not influenced by subsequent modalities of care, they can be considered as valid early severity scores in CDH and used for comparing strategies and/or performances of different centers.
