Prognostic value of the oxygenation index to predict survival in infants with congenital diaphragmatic hernia

Sarkhan Elbayiyev; Esra Beser; Gulsum Kadioglu Simsek; Bengu Karacaglar; Hayriye Gozde Kanmaz Kutman; Fuat Emre Canpolat

doi:10.47338/jns.v11.1107

Authors

Sarkhan Elbayiyev Ankara City Hospital
Esra Beser
Gulsum Kadioglu Simsek
Bengu Karacaglar
Hayriye Gozde Kanmaz Kutman
Fuat Emre Canpolat

DOI:

https://doi.org/10.47338/jns.v11.1107

Keywords:

Congenital diaphragmatic hernia, Newborn, Mortality, Oxygenation Index, Pulmonary hypertension, Extracorporeal membrane oxygenation

Abstract

Background: Congenital Diaphragmatic Hernia (CDH) is associated with significant morbidity and mortality. We aimed to investigate the relationship between survival and oxygenation index calculated in the first 12 hours of life in neonates with CDH.

Methods: Various scoring systems have been developed to predict and determine the course of the disease in this disease group with a high mortality rate. In our study, we planned to investigate the use of APGAR scores, Neonatal acute physiological perinatal spread score-II, and oxygenation index in predicting survival. Patients born in Ankara City Hospital between March 2019 and November 2021 and followed up due to congenital diaphragmatic hernia were included in the study. Preductal oxygen saturation (sPO2) was manipulated to be 80-95% and postductal >70%. Target PaCO2 values were set to be 50-70 mmHg. Oxygenation index scores were calculated using the formula mean airway pressure (MAP) (cmH2O) x fraction of inspired oxygen (FiO2) (%) / partial pressure of arterial oxygen (PaO2) (mmHg).

Results: The 5th-minute APGAR scores of the patients with the congenital diaphragmatic hernia in our study were lower in the non-survivors group than the survivors group (p=0.010). SNAPPE-II and OI scores were statistically significantly higher in the nonsurvivors group (p=0.003 and p=0.002).

Conclusion: The oxygenation index was determined to be an independent predictive parameter in mortality (OR: 4.519 CI: 1.301-654.645, p=0.034). The results of our study show that the oxygenation index is a reliable parameter in predicting survival.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

References

Lally KP. Congenital diaphragmatic hernia. Current Opin Pediatr. 2002; 14:486-90.

Langham MR, Jr, Kays DW, Ledbetter DJ, Frentzen B, Sanford LL, Richards DS. Congenital diaphragmatic hernia. Epidemiology and outcome. Clin Perinatol. 1996; 23:671-88.

van den Hout L, Reiss I, Felix JF, Hop WC, Lally PA, Lally KP, et al. Risk factors for chronic lung disease and mortality in newborns with congenital diaphragmatic hernia. Neonatol. 2010; 98:370-80.

Skari H, Bjornland K, Haugen G, Egeland T, Emblem R. Congenital diaphragmatic hernia: a meta-analysis of mortality factors. J Pediatr Surg. 2000; 35:1187-97.

Stege G, Fenton A, Jaffray B. Nihilism in the 1990s: the true mortality of congenital diaphragmatic hernia. Pediatr. 2003; 112:532-5.

Reiss I, Schaible T, van den Hout L, Capolupo I, Allegaert K, van Heijst A, et al. Standardized postnatal management of infants with congenital diaphragmatic hernia in Europe: the CDH EURO Consortium consensus. Neonatol. 2010; 98:354-64.

Vuletin JF, Lim FY, Cnota J, Kline-Fath B, Salisbury S, Haberman B, et al. Prenatal pulmonary hypertension index: a novel prenatal predictor of severe postnatal pulmonary artery hypertension in the antenatally diagnosed congenital diaphragmatic hernia. J Pediatr Surg. 2010; 45:703-8.

Ruttenstock E, Wright N, Barrena S, Krickhahn A, Castellani C, Desai AP, et al. Best oxygenation index on day 1: a reliable marker for outcome and survival in infants with congenital diaphragmatic hernia. Eur J Pediatr Surg. 2015; 25:3-8.

Mann PC, Morris FH, Jr, Klein JM. Prediction of survival in infants with congenital diaphragmatic hernia based on stomach position, surgical timing, and oxygenation index. Am J Perinatol. 2012; 29:383-90.

Jani J, Nicolaides KH, Keller RL, Benachi A, Peralta CF, Favre R, et al. Observed to expected lung area to head circumference ratio in the prediction of survival in fetuses with isolated diaphragmatic hernia. Ultrasound Obstet Gynecol. 2007; 30:67-71.

Lally KP, Lasky RE, Lally PA, Bagolan P, Davis CF, Frenckner BP, et al. Standardized reporting for congenital diaphragmatic hernia--an international consensus. J Pediatr Surg. 2013; 48:2408-15.

Richardson DK, Corcoran JD, Escobar GJ, Lee SK. SNAP-II and SNAPPE-II: Simplified newborn illness severity and mortality risk scores. J Pediatr. 2001; 138:92-100.

Snoek KG, Reiss IK, Greenough A, Capolupo I, Urlesberger B, Wessel L, et al. Standardized postnatal management of infants with congenital diaphragmatic hernia in Europe: The CDH EURO Consortium Consensus - 2015 Update. Neonatol. 2016; 110:66-74.

Gentili A, Pasini L, Iannella E, Landuzzi V, Lima M, Bacchi Reggiani ML, et al. Predictive outcome indexes in neonatal congenital diaphragmatic hernia. J Matern Fetal Neonatal Med. 2015; 28:1602-7.

Chiu LW, Desai J, Shanti C, Rane S, Agarwal P, Thomas RL, et al. SNAPPE II score as a predictor of survival in neonates with congenital diaphragmatic hernia: A single center experience. Eur J Pediatr Surg. 2016; 26:316-21.

Jancelewicz T, Brindle ME. Prediction tools in congenital diaphragmatic hernia. Semin Perinatol. 2020; 44:151165.

Le LD, Keswani SG, Biesiada J, Lim FY, Kingma PS, Haberman BE, et al. The congenital diaphragmatic hernia composite prognostic index correlates with survival in left-sided congenital diaphragmatic hernia. J Pediatr Surg. 2012; 47:57-62.

Bruns AS, Lau PE, Dhillon GS, Hagan J, Kailin JA, Mallory GB, et al. Predictive value of oxygenation index for outcomes in left-sided congenital diaphragmatic hernia. J Pediatr Surg. 2018; 53:1675-80.

Salas GL, Otaño JC, Cannizzaro CM, Mazzucchelli MT, Goldsmit GS. Congenital diaphragmatic hernia: postnatal predictors of mortality. Archivos Argentinos de Pediatría. 2020; 118:173-9.

Tan YW, Ali K, Andradi G, Sasidharan L, Greenough A, Davenport M. Prognostic value of the oxygenation index to predict survival and timing of surgery in infants with congenital diaphragmatic hernia. J Pediatr Surg. 2019; 54:1567-72.

Tan YW, Adamson L, Forster C, Davies B, Sharkey D. Using serial oxygenation index as an objective predictor of survival for antenatally diagnosed congenital diaphragmatic hernia. J Pediatr Surg. 2012; 47:1984-9.

Reyes C, Chang LK, Waffarn F, Mir H, Warden MJ, Sills J. Delayed repair of congenital diaphragmatic hernia with early high-frequency oscillatory ventilation during preoperative stabilization. J Pediatr Surg. 1998; 33:1010-4.

Oh C, Youn JK, Han JW, Yang HB, Lee S, Seo JM, et al. Predicting survival of congenital diaphragmatic hernia on the first day of life. World J Surg. 2019; 43:282-90.

Frenckner B, Ehrén H, Granholm T, Lindén V, Palmér K. Improved results in patients who have congenital diaphragmatic hernia using preoperative stabilization, extracorporeal membrane oxygenation, and delayed surgery. J Pediatr Surg. 1997; 32:1185-9.

Downard CD, Jaksic T, Garza JJ, Dzakovic A, Nemes L, Jennings RW, et al. Analysis of an improved survival rate for congenital diaphragmatic hernia. J Pediatr Surg. 2003; 38:729-32.

Muratore CS, Kharasch V, Lund DP, Sheils C, Friedman S, Brown C, et al. Pulmonary morbidity in 100 survivors of congenital diaphragmatic hernia monitored in a multidisciplinary clinic. J Pediatr Surg. 2001; 36:133-40.

Guidry CA, Hranjec T, Rodgers BM, Kane B, McGahren ED. Permissive hypercapnia in the management of congenital diaphragmatic hernia: our institutional experience. J Am Coll Surg. 2012; 214:640-5.

Harting MT. Congenital diaphragmatic hernia-associated pulmonary hypertension. Semin Pediatr Surg. 2017; 26:147-53.

Lakshminrusimha S, Keszler M, Kirpalani H, Van Meurs K, Chess P, Ambalavanan N, et al. Milrinone in congenital diaphragmatic hernia - a randomized pilot trial: study protocol, review of literature and survey of current practices. Matern Heal, Neonatol Perinatol. 2017; 3:27.

Kipfmueller F, Schroeder L, Berg C, Heindel K, Bartmann P, Mueller A. Continuous intravenous sildenafil as an early treatment in neonates with congenital diaphragmatic hernia. Pediatr Pulmonol. 2018; 53:452-60.

Yu PT, Jen HC, Rice-Townsend S, Guner YS. The role of ECMO in the management of congenital diaphragmatic hernia. Semin Perinatol. 2020; 44:151166.

Guner Y, Jancelewicz T, Di Nardo M, Yu P, Brindle M, Vogel AM, et al. Management of congenital diaphragmatic hernia treated with extracorporeal life support: Interim guidelines consensus statement from the Extracorporeal Life Support Organization. ASAIO J. 2021; 67:113-20.

Moyer V, Moya F, Tibboel R, Losty P, Nagaya M, Lally KP. Late versus early surgical correction for congenital diaphragmatic hernia in newborn infants. Cochrane Database Syst Rev. 2002:Cd001695.

Hollinger LE, Lally PA, Tsao K, Wray CJ, Lally KP. A risk-stratified analysis of delayed congenital diaphragmatic hernia repair: does timing of operation matter? Surg. 2014; 156:475-82.

Rozmiarek AJ, Qureshi FG, Cassidy L, Ford HR, Hackam DJ. Factors influencing survival in newborns with congenital diaphragmatic hernia: the relative role of timing of surgery. J Pediatr Surg. 2004; 39:821-4.