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Predictive outcome indexes in neonatal Congenital Diaphragmatic Hernia
A Gentili1, L Pasini, E Iannella
1a Department of Paediatric Anaesthesia and Intensive Care .
Insights
Predicting congenital diaphragmatic hernia (CDH) outcomes is highly reliable using postnatal indexes. While prenatal factors offer limited prediction, various postnatal clinical values and scores accurately assess CDH prognosis in neonates.
Area of Science:
- Neonatalogy
- Pediatric Surgery
- Medical Prognostics
Background:
- Congenital diaphragmatic hernia (CDH) is a serious condition requiring accurate outcome prediction.
- Reliable prognostic indicators are crucial for managing neonates with CDH.
Purpose of the Study:
- To evaluate the reliability of prenatal and postnatal prognostic indexes for congenital diaphragmatic hernia (CDH) outcomes.
- To identify key factors that accurately predict survival in neonates with CDH.
Main Methods:
- Analysis of 77 neonates diagnosed with CDH.
- Categorization of prognostic factors into prenatal findings and postnatal clinical values/scores.
- Comparison of data between survivor and non-survivor groups.
Main Results:
- Prenatal factors like major anomalies, intrathoracic stomach, early diagnosis (<25 weeks GA), and lung-to-head ratio <0.6 were more common in non-survivors.
- Postnatal values at PICU admission (e.g., paO2/FiO2, oxygenation index, pH, blood pressure) reliably indicated CDH outcome.
- All assessed postnatal predictive scores (Apgar, CDH-Study-Group, SNAP-II, PRAM III, etc.) were statistically significant, with better scores in survivors.
Conclusions:
- Predicting congenital diaphragmatic hernia (CDH) outcomes is feasible with high accuracy.
- Prenatal indicators for CDH prognosis are limited.
- Numerous postnatal indexes and scores provide reliable prediction of CDH outcomes.
Objective:
We examined the reliability of the main prenatal and postnatal prognosis-related indexes that can be used to evaluate congenital diaphragmatic hernia (CDH) outcome.
Methods:
Seventy-seven neonates with CDH were analyzed according to CDH prognosis-related factors, divided into prenatal findings, postnatal clinical values and postnatal predictive outcome scores applied at birth and within the first 12-24 h. The data are compared between two groups: survivors and non-survivors.
Results:
During prenatal age, major associated anomalies, intrathoracic stomach, diagnosis prior to 25 weeks of gestational age and lung-to-head ratio < 0.6 were statistically significant, demonstrating their greater incidence in non-survivors. The majority of postnatal values at PICU admission were found to be reliable in identifying the CDH outcome: paO2/FiO2, oxygenation index, alveolar-arterial-O2 gradient, arterial-alveolar-O2 tension ratio, pH, mean blood pressure, body temperature. All the postnatal predictive outcome scores (Apgar 1' and 5', CDH-Study-Group equation, Score for Neonatal-Acute-Physiology II, SNAP-Perinatal-Extension II, Pediatric Risk of Mortality III and Wilford-Hall/Santa-Rosa formula) were statistically significant with more favorable values for prognosis in the survivors group.
Conclusion:
The chances of predicting CDH outcome are fairly high. During prenatal age, only a few findings may be obtained. Conversely, many postnatal indexes and scores can reliably predict such outcome.
