Comparison of early postnatal prediction models for survival in congenital diaphragmatic hernia

Abstract

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.

Outcome of Congenital Diaphragmatic Hernia: A Single Center Experience

“…Previous studies have reported that the predictor's of poor outcome included lung to head ratio <1.4, significantly elevated PCO2 (>90) in the first 24 hours, severe PPHN with cardiac dysfunction, hypoplastic left ventricle and liver and stomach herniation to thorax and prematurity. [5,6,[9][10][11][12] Our data concur with these markers but liver and stomach herniation were not poor outcome predictors.…”

“…[2] Several variable predictors of poor outcome have been identified in various studies. [3][4][5][6][7][8][9] In this single center study, we have reviewed the outcome of newborns with CDH and attempted to identify predictors of outcome in our cohort.…”

Comparison of CDHSG model and PCO2 in predicting mortality risk in patients with congenital diaphragmatic hernia

“…It has been confirmed that the CDHSG model can predict survival with an AUC of 0.79 9 . In some studies, it has been revealed that the AUC value of the CDHSG model is 0.74, providing a good survival prediction, and the mortality rate increases as the risk score increases 7,13 . In their study, Patel et al 8 reported a high performance with AUC 0.88 in the prediction of PCO 2 > 60 mortality in the first 24 h of blood gas.…”

“…It has been revealed that in low birth weight or preterm infants, CDH progresses poorly, and the survival rate is low 2,4–6 . The degree of pulmonary hypoplasia, the adequacy of ventilation oxygenation and pulmonary hypertension determines the course of CDH 1,2,7 . In 2014, a clinical prediction rule consisting of birth weight, 5‐min Apgar score, pulmonary hypertension, accompanying chromosomal anomaly, or congenital cardiac anomalies was developed by the Congenital Diaphragmatic Hernia Study Group (CDHSG) to determine the severity of CDH 3 .…”

“…2,[4][5][6] The degree of pulmonary hypoplasia, the adequacy of ventilation oxygenation and pulmonary hypertension determines the course of CDH. 1,2,7 In 2014, a clinical prediction rule consisting of birth weight, 5-min Apgar score, pulmonary hypertension, accompanying chromosomal anomaly, or congenital cardiac anomalies was developed by the Congenital Diaphragmatic Hernia Study Group (CDHSG) to determine the severity of CDH. 3 It has been suggested that the severity of CDH can be determined only by considering arterial blood gas on the first postnatal day, and a PCO 2 of ≥60 has a high predictiveness for mortality.…”