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Does a highest pre-ductal O2 saturation <85% predict non-survival for congenital diaphragmatic hernia?

Journal of Perinatology volume 32, pages 947–952 (2012)Cite this article

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Abstract

Objective:

To analyze operative repair, extracorporeal membrane oxygenation (ECMO) and survival rates based on highest pre-ductal oxygen saturation (Pre-O2SAT) in a large infant cohort reported to Congenital Diaphragmatic Hernia Study Group Registry between 2000 and 2010.

Study Design:

Analyzed data included gestational age, birth weight, defect side and size, repair, ECMO use, survival and highest reported PaO2 and Pre-O2SAT in first 24 h of life. We excluded 614 infants due to severe anomaly. Pre-O2SAT data were available for 1672 infants.

Result:

Among infants with highest Pre-O2SAT value <85%, survival (24/105=23%) and repair (55/105=52%) rates were significantly decreased compared with infants with higher values. Survival increased to 44% for infants with highest Pre-O2SAT<85% who underwent operative repair. Of these, 83% (20/24) required ECMO support compared with 15% (144/961) of survivors with Pre-O2SAT>99% (P<0.001). The lowest reported Pre-O2SAT with survival was 32% and for survival without ECMO was 52%.

Conclusion:

A reported highest Pre-O2SAT<85% in the first 24 h of life was not uniformly fatal; but survival of infants with Pre-O2SAT<85% was associated with high ECMO use and prolonged hospitalization.

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References

  1. Cannon C, Dildy GA, Ward R, Varner MW, Dudley DJ . A population-based study of congenital diaphragmatic hernia in Utah: 1988–1994. Obstet Gynecol 1996; 87: 959–963.

    Article  CAS  Google Scholar 

  2. Colvin J, Bower C, Dickinson JE, Sokol J . Outcomes of congenital diaphragmatic hernia: a population-based study in Western Australia. Pediatrics 2005; 116: e356–e363.

    Article  Google Scholar 

  3. Stege G, Fenton A, Jaffray B . Nihilism in the 1990s: the true mortality of congenital diaphragmatic hernia. Pediatrics 2003; 112: 532–535.

    Article  Google Scholar 

  4. Wung JT, Sahni R, Moffitt ST, Lipsitz E, Stolar CJ . Congenital diaphragmatic hernia: survival treated with very delayed surgery, spontaneous respiration, and no chest tube. J Pediatr Surg 1995; 30: 406–409.

    Article  CAS  Google Scholar 

  5. Boloker J, Bateman DA, Wung JT, Stolar CJ . Congenital diaphragmatic hernia in 120 infants treated consecutively with permissive hypercapnea/spontaneous respiration/elective repair. J Pediatr Surg 2002; 37: 357–366.

    Article  Google Scholar 

  6. Bohn D . Congenital diaphragmatic hernia. Am J Respir Crit Care Med 2002; 166: 911–915.

    Article  Google Scholar 

  7. Kays DW, Langham Jr MR, Ledbetter DJ, Talbert JL . Detrimental effects of standard medical therapy in congenital diaphragmatic hernia. Ann Surg 1999; 230: 340–348; discussion 348–351.

    Article  CAS  Google Scholar 

  8. Downard CD, Jaksic T, Garza JJ, Dzakovic A, Nemes L, Jennings RW, Wilson JM . Analysis of an improved survival rate for congenital diaphragmatic hernia. J Pediatr Surg 2003; 38: 729–732.

    Article  Google Scholar 

  9. Frenckner B, Ehren H, Granholm T, Linden V, Palmer K . Improved results in patients who have congenital diaphragmatic hernia using preoperative stabilization, extracorporeal membrane oxygenation, and delayed surgery. J Pediatr Surg 1997; 32: 1185–1189.

    Article  CAS  Google Scholar 

  10. Hoffman SB, Massaro AN, Gingalewski C, Short BL . Survival in congenital diaphragmatic hernia: use of predictive equations in the ECMO population. Neonatology 2011; 99: 258–265.

    Article  Google Scholar 

  11. Tsao K, Lally KP . The Congenital Diaphragmatic Hernia Study Group: a voluntary international registry. Semin Pediatr Surg 2008; 17: 90–97.

    Article  Google Scholar 

  12. Schultz CM, DiGeronimo RJ, Yoder BA . Congenital diaphragmatic hernia: a simplified postnatal predictor of outcome. J Pediatr Surg 2007; 42: 510–516.

    Article  Google Scholar 

  13. Graziano JN . Cardiac anomalies in patients with congenital diaphragmatic hernia and their prognosis: a report from the Congenital Diaphragmatic Hernia Study Group. J Pediatr Surg 2005; 40: 1045–1049; discussion 1049–1050.

    Article  Google Scholar 

  14. Sweed Y, Puri P . Congenital diaphragmatic hernia: influence of associated malformations on survival. Arch Dis Child 1993; 69: 68–70.

    Article  CAS  Google Scholar 

  15. Raval MV, Wang X, Reynolds M, Fischer AC . Costs of congenital diaphragmatic hernia repair in the United States-extracorporeal membrane oxygenation foots the bill. J Pediatr Surg 2011; 46: 617–624.

    Article  Google Scholar 

  16. Logan JW, Cotten CM, Goldberg RN, Clark RH . Mechanical ventilation strategies in the management of congenital diaphragmatic hernia. Semin Pediatr Surg 2007; 16: 115–125.

    Article  Google Scholar 

Download references

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Authors and Affiliations

  1. Department of Pediatrics, University of Utah and Primary Children's Medical Center, Salt Lake City, UT, USA

    B A Yoder

  2. Department of Pediatric Surgery, UT Health Medical School and Children's Memorial Hermann Hospital, Houston, TX, USA

    P A Lally & K P Lally

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  1. B A Yoder
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  2. P A Lally
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The Congenital Diaphragmatic Hernia Study Group

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Correspondence to B A Yoder.

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Yoder, B., Lally, P., Lally, K. et al. Does a highest pre-ductal O2 saturation <85% predict non-survival for congenital diaphragmatic hernia?. J Perinatol 32, 947–952 (2012). https://doi.org/10.1038/jp.2012.18

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