Respiratory Severity Score as a Predictive Factor for the Mortality of Congenital Diaphragmatic Hernia

Abstract

Purpose: Congenital diaphragmatic hernia (CDH) is rare but potentially fatal. The overall outcome is highly variable. This study aimed to identify a simple and dynamic parameter that helps predict the mortality of CDH patients in real time, without inva sive tests. Methods: We conducted a retrospective chart review of 59 CDH cases. Maternal and fetal information included the gestational age at diagnosis, site of defect, presence of liver herniation, and lungtohead ratio (LHR) at 20 to 29 weeks of gestational age. Information regarding postnatal treatment, including the number of days until surgery, the need for inhaled nitric oxide (iNO), the need for extracorporeal mem brane oxygenation (ECMO), and survival, was collected. The highest respiratory se verity score (RSS) within 24 hours after birth was also calculated. Results: Statistical analysis showed that a younger gestational age at the initial dia gnosis (P<0.001), a lower LHR (P=0.001), and the presence of liver herniation (P= 0.003) were prenatal risk factors for CDH mortality. The RSS and use of iNO and ECMO were significant factors affecting survival. In the multivariate analysis, the only remaining significant risk factor was the highest preoperative RSS within 24 hours after birth (P=0.002). The area under the receiver operating characteristic curve was 0.9375, with a sensitivity of 91.67% and specificity of 83.87% at the RSS cutoff value of 5.2. The positive and negative predictive values were 82.14% and 92.86%, respectively. Conclusion: Using the RSS as a prognostic predictor with simple calculations will help clinicians plan CDH management.

The Utility of serial Echocardiography parameters in the Management of newborns with Congenital `Diaphragmatic Hernia (CDH) and predictors of Mortality

“…Higher Post-operative VIS and RSS scores were predictive of mortality in our cohort. This is consistent with previous studies reporting on the use of RSS as a predictor of mortality [31] and higher post-op VIS scores being predictive of negative outcomes in infants with CDH [51]. VIS more than 23 was associated with high mortality in our cohort.…”

“…The improved trends pre-operatively RSS, TAPSE, and RVSP indicate that clinicians endeavoured to achieve cardiovascular stability in patients prior to surgery with regards to need for respiratory support, right ventricular systolic function, and pulmonary pressures. Pre-operative high RSS, pulmonary pressures and poor right ventricular function are important factors associated with mortality and morbidity in patients with CDH, and therefore the stability of these parameters is commonly practised [31,53,54]. RSS and pulmonary pressures in the immediate preoperative period were also assessed to be potential predictors but did not achieve statistical signi cance, likely due to our small numbers.…”

“…Respiratory severity score (RSS) was calculated using the formula of mean airway pressure (MAP) x fractional inspired oxygen (FiO2), which was considered as a marker of severity of illness [31]. Subgroup analysis was done comparing newborns with RSS less than 4 versus more than 4 as a severity cut-off used in previously published studies [31].…”

The Utility of Serial Echocardiography Parameters in Management of Newborns with Congenital Diaphragmatic Hernia (CDH) and Predictors of Mortality

“…Higher Post-operative VIS and RSS scores were predictive of mortality in our cohort. This is consistent with previous studies reporting on the use of RSS as a predictor of mortality [32] and higher post-op VIS scores being predictive of negative outcomes in infants with CDH [51]. VIS more than 23 was associated with high mortality in our cohort.…”

“…Respiratory severity score (RSS) was calculated using mean airway pressure (MAP) x fractional inspired oxygen (FiO2), and was considered as a marker of severity of illness [32]. Subgroup analysis was done comparing newborns with RSS less than 4 versus more than 4 as a severity cut-off used in previously published studies [32].…”