Survival prediction of high-risk outborn neonates with congenital diaphragmatic hernia from capillary blood gases

BMC Pediatrics

Research Article

Toby N. Weingarten¹  Juraj Sprung¹  Katarina Bojanić²  Tomislav Luetić³  Ena Pritišanac⁴  Ruža Grizelj⁴  Jurica Vuković⁴  Darrell R. Schroeder⁵ 

[1] Department of Anesthesiology, Mayo Clinic, 200 First St SW, 55905, Rochester, MN, USA;Department of Obstetrics and Gynecology, University Hospital Merkur, Zagreb, Croatia;Department of Pediatric Surgery, University of Zagreb, School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia;Department of Pediatrics, University of Zagreb, School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia;Division of Biomedical Statistics and Informatics, Mayo Clinic, 200 First St SW, 55905, Rochester, MN, USA;

关键词: Congenital diaphragmatic hernia;    Outcome;    Survival;    Clinical prediction;    Risk assessment;    Capillary blood gases;    Outborn;   

DOI  :  10.1186/s12887-016-0658-y

 received in 2015-08-12, accepted in 2016-07-26,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundThe extent of lung hypoplasia in neonates with congenital diaphragmatic hernia (CDH) can be assessed from gas exchange. We examined the role of preductal capillary blood gases in prognosticating outcome in patients with CDH.MethodsWe retrospectively reviewed demographic data, disease characteristics, and preductal capillary blood gases on admission and within 24 h following admission for 44 high-risk outborn neonates. All neonates were intubated after delivery due to acute respiratory distress, and were emergently transferred via ground ambulance to our unit between 1/2000 and 12/2014. The main outcome measure was survival to hospital discharge and explanatory variables of interest were preductal capillary blood gases obtained on admission and during the first 24 h following admission.ResultsHigher ratio of preductal partial pressure of oxygen to fraction of inspired oxygen (PcO2/FIO2) on admission predicted survival (AUC = 0.69, P = 0.04). However, some neonates substantially improve PcO2/FIO2 following initiation of treatment. Among neonates who survived at least 24 h, the highest preductal PcO2/FIO2 achieved in the initial 24 h was the strongest predictor of survival (AUC = 0.87, P = 0.002). Nonsurvivors had a mean admission preductal PcCO2 higher than survivors (91 ± 31 vs. 70 ± 25 mmHg, P = 0.02), and their PcCO2 remained high during the first 24 h of treatment.ConclusionThe inability to achieve adequate gas exchange within 24 h of initiation of intensive care treatment is an ominous sign in high-risk outborn neonates with CDH.We suggest that improvement of oxygenation during the first 24 h, along with other relevant clinical signs, should be used when making decisions regarding treatment options in these critically ill neonates.

【 授权许可】

CC BY   
© The Author(s). 2016