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The Oxygen Saturation Index as Early Predictor of Outcomes in Congenital Diaphragmatic Hernia
Emily J J Horn-Oudshoorn1, Marijn J Vermeulen2, Ronny Knol2
1Division of Neonatology, Department of Pediatrics, Erasmus MC University Medical Center, Rotterdam, The Netherlands, e.horn-oudshoorn@erasmusmc.nl.
Insights
Oxygen saturation index (OSI) effectively predicts clinical deterioration in infants with congenital diaphragmatic hernia (CDH). Early OSI monitoring aids in identifying high-risk neonates for timely intervention and tailored postnatal management.
Area of Science:
- Neonatal Medicine
- Pediatric Surgery
- Critical Care
Background:
- Congenital diaphragmatic hernia (CDH) poses significant risks for neonatal clinical deterioration.
- Early identification of high-risk infants with CDH is crucial for optimizing outcomes.
- Current predictive markers for CDH complications may lack sensitivity or timeliness.
Purpose of the Study:
- To evaluate the oxygen saturation index (OSI) as an early predictor of clinical deterioration in infants with CDH.
- To assess the association between OSI values and adverse outcomes such as pulmonary hypertension, ECMO-therapy, and mortality.
- To determine the discriminative ability of OSI measurements in the first 24 hours after birth.
Main Methods:
- Retrospective cohort study of consecutive infants with isolated CDH.
- Continuous OSI measurements collected within the first 24 hours post-birth.
- Receiver operator characteristic (ROC) analysis to evaluate discriminative values of maximum and mean OSI.
Main Results:
- In 42 infants, median OSI was 5.0; 27 developed pulmonary hypertension, 15 required ECMO, and 6 died.
- Maximum OSI values correlated with pulmonary hypertension, ECMO-therapy, and mortality.
- Mean OSI values demonstrated excellent discriminative ability for ECMO-therapy and mortality, and acceptable ability for pulmonary hypertension.
Conclusions:
- Continuous OSI monitoring is a promising tool for early identification of infants at high risk of deterioration.
- OSI measurements in the initial hours after birth can help establish discriminative cut-offs for adverse outcomes.
- This approach allows for tailored postnatal management strategies based on individual patient risk profiles.
Objective:
The aim of the study was to evaluate the oxygen saturation index (OSI) as an early predictor of clinical deterioration in infants with congenital diaphragmatic hernia (CDH).
Methods:
A single-center retrospective cohort study was conducted in consecutive infants with isolated CDH with continuous OSI measurements collected in the first 24 h after birth between June 2017 and July 2021. Outcomes of interest were pulmonary hypertension, extracorporeal membrane oxygenation (ECMO)-therapy, and mortality. We evaluated the discriminative values of the maximum OSI value and of mean OSI values with receiver operator characteristic (ROC) analysis and the area under the ROC curve.
Results:
In 42 infants with 49,473 OSI measurements, the median OSI was 5.0 (interquartile range 3.1-10.6). Twenty-seven infants developed pulmonary hypertension on a median of day 1 (1-1), of which 15 infants had an indication for ECMO-therapy, and 6 infants died. Maximum OSI values were associated with pulmonary hypertension, ECMO-therapy, and mortality. Mean OSI values had an acceptable discriminative ability for pulmonary hypertension and an excellent discriminative ability for ECMO-therapy and mortality. Although OSI measurements were not always present in the first hours after birth, we determined discriminative cut-offs for mean OSI values already in these first hours for pulmonary hypertension, the need for ECMO-therapy, and mortality.
Conclusions:
Continuous OSI evaluation is a promising modality to identify those infants at highest risk for clinical deterioration already in the first hours after birth. This provides an opportunity to tailor postnatal management based on the individual patient's needs.
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