Objective To compare the PF-PCO 2 equation-partial pressure of arterial oxygen (PaO 2)/fraction of inspired oxygen (FiO 2) minus partial pressure of carbon dioxide (PCO 2)-to three other tools for postnatal prediction of survival in infants with congenital diaphragmatic hernia (CDH). Study design A retrospective analysis of 203 infants with CDH from 1 January 2003 to 30 June 2018. Area under the curve (AUC) analysis was performed for survival and secondary outcomes of survival without extracorporeal membrane oxygenation support (ECMO) and death despite ECMO. Predictive scores were calculated to determine cutoff for PF-PCO 2 score. Results The PF-PCO 2 tool had the highest AUC (0.84 for survival, 0.92 for survival without ECMO, and 0.83 for death despite ECMO). PF-PCO 2 best predicted survival when >−60 and survival without ECMO when >+80. There was no optimal cutoff score for death despite ECMO. Conclusion The PF-PCO 2 tool best predicted postnatal survival in infants with CDH.

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There is no clear consensus on optimal management of fetuses affected by familial hypertrophic cardiomyopathy (HCM). Intrauterine treatment of the condition has not been attempted in any standardized fashion. We report the case of a fetus treated by maternal propranolol during the third trimester after septal hypertrophy and diastolic dysfunction was diagnosed on fetal echocardiogram. The pregnancy went successfully to term, and fetal septal hypertrophy was noted to improve prior to delivery.

BackgroundNecrotizing enterocolitis (NEC) is a serious complication of prematurity. Our objective was to evaluate the impact of an umbilical cord milking protocol (UCM) and pasteurized donor human milk (PDHM) on NEC rates in infants less than 30 weeks gestational age from January 1, 2010 to September 30, 2016. We hypothesized an incremental decrease in NEC after each intervention.MethodsWe performed a retrospective review of 638 infants born less than 30 weeks gestational age. Infants were grouped into three epochs: pre-UCM/pre-PDHM (Epoch 1, n = 159), post-UCM/pre-PDHM (Epoch 2, n = 133), and post-UCM/post-PDHM (Epoch 3, n = 252). The incidence of NEC, surgical NEC, and NEC/death were compared. Logistic regression was used to determine independent significance of time epoch, gestational age, birth weight, and patent ductus arteriosus for NEC, surgical NEC, and death/NEC.ResultsAt birth, infants in Epoch 1 were younger than Epoch 2 and 3 (26.8 weeks versus 27.3 and 27.2, respectively, P = 0.036) and smaller (910 g versus 1012 and 983, respectively, P = 0.012). Across epochs, there was a significant correlation between patent ductus arteriosus treatment and NEC rate (P < 0.001, Cochran-Mantel-Haenszel). There was a significant decrease in rates of NEC, surgical NEC, and NEC/death between groups. Logistic regression showed this as significant for rates of NEC and surgical NEC between Epoch 1 and 3. Patent ductus arteriosus was a significant variable affecting the incidence of NEC, but not surgical NEC or death/NEC.ConclusionsAn umbilical cord milking protocol and pasteurized donor human milk availability was associated with decreased rates of NEC and surgical NEC. This suggests an additive effect of these interventions in preventing NEC.