Ashley S Bruns1, Patricio E Lau2, Gurpreet S Dhillon3, Joseph Hagan4, Joshua A Kailin3, George B Mallory5, Pablo Lohmann6, Oluyinka O Olutoye2, Rodrigo Ruano7, Caraciolo J Fernandes6. 1. Section of Neonatology, Baylor College of Medicine/Texas Children's Hospital, Houston, TX, USA. Electronic address: bruns@bcm.edu. 2. Department of Pediatric Surgery, Baylor College of Medicine/Texas Children's Hospital, Houston, TX, USA. 3. Section of Pediatric Cardiology, Baylor College of Medicine/Texas Children's Hospital, Houston, TX, USA. 4. Center for Research & Evidence Based Practice, Texas Children's Hospital, Houston, TX, USA. 5. Department of Pediatric Pulmonary Medicine, Baylor College of Medicine/Texas Children's Hospital, Houston, TX, USA. 6. Section of Neonatology, Baylor College of Medicine/Texas Children's Hospital, Houston, TX, USA. 7. Department of Obstetrics and Gynecology, Mayo Clinic School of Medicine, Rochester, MN, USA.
Abstract
BACKGROUND & OBJECTIVES: Congenital Diaphragmatic Hernia (CDH) is associated with significant morbidity and mortality. This study compares the efficacy of the highest oxygenation index in the first 48 h (HiOI) versus current prenatal indices to predict survival and morbidity. METHODS: Medical records of 50 prenatally diagnosed, isolated, left-sided CDH patients treated from January 2011 to April 2016 were reviewed. Data abstracted included HiOI, lung to head ratio (LHR), observed to expected total fetal lung volume (O/E TFLV), percent liver herniation (%LH), 6 month survival, respiratory support at discharge, ventilator days and length of stay. Data were analyzed using parametric and nonparametric tests and regression analyses as appropriate. RESULTS: HiOI was associated with significantly increased LOS (p<0.001), respiratory support at discharge (p<0.001), greater ventilator days (p=0.001) and higher odds of death (p=0.004) with risk of death increasing by 5% for every one-unit increase in OI. HiOI was statistically a better predictor of LOS than O/E TFLV (p=0.007) and %LH (p=0.02). CONCLUSIONS: In isolated, left-sided CDH patients, HiOI is associated with higher mortality, greater length of stay, more ventilator days and increased respiratory support at discharge. HiOI is a better predictor of length of stay than O/E TFLV and %LH. TYPE OF STUDY: Retrospective Study LEVEL OF EVIDENCE: II.
BACKGROUND & OBJECTIVES:Congenital Diaphragmatic Hernia (CDH) is associated with significant morbidity and mortality. This study compares the efficacy of the highest oxygenation index in the first 48 h (HiOI) versus current prenatal indices to predict survival and morbidity. METHODS: Medical records of 50 prenatally diagnosed, isolated, left-sided CDHpatients treated from January 2011 to April 2016 were reviewed. Data abstracted included HiOI, lung to head ratio (LHR), observed to expected total fetal lung volume (O/E TFLV), percent liver herniation (%LH), 6 month survival, respiratory support at discharge, ventilator days and length of stay. Data were analyzed using parametric and nonparametric tests and regression analyses as appropriate. RESULTS: HiOI was associated with significantly increased LOS (p<0.001), respiratory support at discharge (p<0.001), greater ventilator days (p=0.001) and higher odds of death (p=0.004) with risk of death increasing by 5% for every one-unit increase in OI. HiOI was statistically a better predictor of LOS than O/E TFLV (p=0.007) and %LH (p=0.02). CONCLUSIONS: In isolated, left-sided CDHpatients, HiOI is associated with higher mortality, greater length of stay, more ventilator days and increased respiratory support at discharge. HiOI is a better predictor of length of stay than O/E TFLV and %LH. TYPE OF STUDY: Retrospective Study LEVEL OF EVIDENCE: II.
Authors: Candace C Style; Oluyinka O Olutoye; Mariatu A Verla; Keila N Lopez; Adam M Vogel; Patricio E Lau; Stephanie M Cruz; Jimmy Espinoza; Caraciolo J Fernandes; Sundeep G Keswani; Timothy C Lee Journal: J Pediatr Surg Date: 2019-02-20 Impact factor: 2.545