Related Experiment Videos
Predictors of survival for infants with congenital diaphragmatic hernia
M A Norden1, W Butt, P McDougall
1Intensive Care Unit, Royal Children's Hospital, Melbourne, Australia.
Insights
Infants with congenital diaphragmatic hernia (CDH) have a stable survival rate. Key clinical parameters like oxygenation index and ventilation index in the first 24 hours can predict survival in neonates with CDH.
Area of Science:
- Pediatric Surgery
- Neonatology
- Critical Care Medicine
Background:
- Congenital diaphragmatic hernia (CDH) survival rates have remained stagnant at 56% despite advancements in neonatal intensive care.
- Emerging treatments like ECMO, high-frequency oscillation, and novel therapies require further evaluation for their role in CDH management.
Purpose of the Study:
- To identify predictive clinical parameters for survival in infants with CDH based on early respiratory and blood gas data.
- To stratify CDH infants into prognostic groups to guide treatment strategies.
Main Methods:
- Analysis of five clinical parameters from the first 24 hours of life in 90 infants with CDH.
- Utilized receiver operating curve analysis to determine optimal predictive values for each parameter.
- Included infants diagnosed within 6 hours, requiring ventilation before repair, and without lethal anomalies.
Main Results:
- An oxygenation index < 0.08 predicted a 94% survival rate (96% sensitivity, 95% specificity).
- A modified ventilation index < 40 predicted a 91% survival rate (94% sensitivity, 86% specificity).
- Three distinct infant groups were identified based on their response to conventional therapy.
Conclusions:
- Early preoperative ventilatory and blood gas parameters are valuable predictors of survival in neonates with CDH.
- Specific oxygenation and ventilation index thresholds can accurately stratify risk and inform clinical management decisions.
- Further research is warranted to optimize the use of advanced therapies in conjunction with these predictive markers.
Abstract:
Over the past decade, the survival rate of infants with congenital diaphragmatic hernia (CDH) treated in the intensive care unit of the Royal Children's Hospital, Melbourne, has remained unchanged at 56% +/- 6%. Newer forms of treatment, such as extracorporeal membrane oxygenation (ECMO), high-frequency oscillation, and surfactant and nitric oxide therapy, are now available. The exact role of these therapies in the management of infants with CDH has not been determined. This study examines five clinical parameters derived from an infant's best preoperative ventilatory and blood gas data in the first 24 hours of life. One hundred twenty-five CDH infants were admitted to the intensive care unit between January 1, 1981 and December 31, 1991. Criteria for inclusion in the study were (1) CDH diagnosed within 6 hours of delivery, (2) ventilation before repair, and (3) no associated lethal congenital abnormality. Of the 90 cases studied in detail, there were 38 deaths (42% mortality rate). All five parameters were analyzed by receiver operating curve analysis to determine the optimum value of each parameter in predicting survival. An oxygenation index (MAP x FIO2/PaO2) of less than 0.08 predicted a 94% chance of survival, with a sensitivity of 96% and a specificity of 95%. Similarly, a modified ventilation index (PIP x RR x CO2/1,000) of less than 40 predicted a 91% chance of survival, with a sensitivity of 94% and a specificity of 86%. By stratifying each criterion according to outcome, three groups of infants were identified according to their response to conventional therapy.(ABSTRACT TRUNCATED AT 250 WORDS)