Retrospective study of 111 cases of congenital diaphragmatic hernia treated with early high-frequency oscillatory ventilation and presurgical stabilization

Migliazza, Lucia; Bellan, Cristina; Alberti, Daniele; Auriemma, A.; Burgio, GiamPiero; Colombo, Giuseppe Locatelli e Angelo

doi:10.1016/j.jpedsurg.2007.04.015

Cited by 137 publications

(78 citation statements)

References 24 publications

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“…That right-sided and bilateral defects are associated with poor prognosis has been reported by others. 23,25,26 Also consistent with other reports was the higher rate of associated anomalies in the nonsurvivor group, 17,19,23,25,26 although this did not reach statistical significance in our series. Although measures of oxygenation were different in univariable analysis, it is of interest that minimum pre-ECMO pCO2 was the only independent predictor of survival in addition to side of defect.…”

Section: Discussionsupporting

confidence: 89%

Predictors of survival in congenital diaphragmatic hernia patients requiring extracorporeal membrane oxygenation: CNMC 15-year experience

et al. 2010

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Objective: To review outcomes of patients with congenital diaphragmatic hernia (CDH) requiring extracorporeal membrane oxygenation (ECMO) at a level IIIC neonatal intensive care unit and to determine if pre-ECMO respiratory status can help predict mortality.Study Design: A single-center retrospective chart review was conducted on all infants with CDH treated with ECMO in the past 15 years. Demographic and clinical information, including pre-ECMO ventilatory and blood gas data, was collected. Differences between survivors and nonsurvivors were evaluated using independent samples t-/Mann-Whitney U-and Fisher's exact/w 2 -tests for continuous and categorical data, respectively. Cox regression analysis was performed to evaluate predictors of survival while controlling for covariates. Significant predictors were further explored with receiver operating characteristic (ROC) curve and Kaplan-Meier survival analysis.Result: Overall survival of the population of 62 patients treated with ECMO was 50%. Survivor and non-survivors were similar in birth weight, gestational age, gender, race and Apgar scores. Approximately 80% of patients in both groups had a left-sided defect. Less than half of patients were prenatally diagnosed in either group. Patients in the non-survivor group had associated anomalies (42 vs 23% for survivors) but this was not statistically significant (P ¼ 0.303). Non-survivors were more likely to be put on ECMO earlier, stay on ECMO longer and be operated upon later. On pre-ECMO blood gas analyses, survivors had higher pH and PaO 2 , and lower oxygenation index and PaCO 2 compared with non-survivors. After controlling for covariates, a lower minimum PaCO 2 and side of defect were the only independent predictors of survival. ROC curve for minimum pre-ECMO PaCO 2 had a significant area under the curve (0.72, P ¼ 0.003). Survival was 27% in babies unable to achieve a pre-ECMO PaCO 2 <60 mm Hg whereas no patients survived if their lowest pre-ECMO PaCO 2 was >70 mm Hg. Conclusion:Minimum achievable pre-ECMO PaCO 2 is an independent predictor of survival in patients with CDH requiring ECMO life support. These data provide useful prognostic information for counseling families and may facilitate direction of care in extreme cases where the degree of pulmonary hypoplasia may be incompatible with life.

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Section: Discussionsupporting

confidence: 89%

Predictors of survival in congenital diaphragmatic hernia patients requiring extracorporeal membrane oxygenation: CNMC 15-year experience

et al. 2010

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“…The incidence of pneumothorax has been reported in 0.5-1% of term neonates [1][2][3] and as high as 11% of extremely low birth weight infants 4 in the NICU. It often occurs spontaneously or as a result of respiratory distress syndrome, infections, 5 meconium aspiration syndrome, 6 congenital diaphragmatic hernia, 7 and more commonly, ventilation barotraumas. 8 Depending on the significance and severity of clinical symptoms, clinicians may choose to treat a pneumothorax conservatively or with thoracocentesis.…”

Section: Introductionmentioning

confidence: 99%

Sequential changes of hemodynamics and blood gases in newborn piglets with developing pneumothorax

Liu

Joynt

Tymafichuk

et al. 2008

Pediatric Pulmonology

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IntroductionLittle information is available regarding the temporal changes in hemodynamics and blood gases during the development of a moderate pneumothorax in a neonate. In this study, we aim to investigate the temporal changes of hemodynamics and arterial blood gases in a neonatal swine model of unilateral pneumothorax.Study DesignProspective observational controlled animal research.MethodsExperimental pneumothorax (n = 9) was created by intermittent progressive introduction of 10 ml/kg of room‐air every 5 min to a total 40 ml/kg, via a 20G Insyte® angiocatheter placed in the fourth intercostal space in line with the right frontal limb. Changes in heart rate, mean arterial pressure, central venous pressure (CVP), common carotid arterial flow (CCAF) and arterial blood gases were measured and compared with the normoxic baseline and a control group (n = 7) (ANOVA).ResultsAs the pneumothorax developed, SaO2 and PaO2 deteriorated after injecting 20 ml/kg of room‐air (P < 0.001 vs. baseline and control), whereas the pH and PaCO2 remained unchanged. CVP increased after injecting 30 ml/kg of room‐air (P < 0.001), with no significant changes in heart rate and mean arterial pressure. Meanwhile, CCAF increased and carotid oxygen delivery declined after 30 ml/kg (P < 0.05).ConclusionsDeterioration in oxygenation was noted early in the development of pneumothorax in newborn piglets followed by metabolic acidosis. CVP progressively increased despite the lack of significant changes in systemic hemodynamics when moderate pneumothorax developed. Although CCAF increased during a moderate pneumothorax, carotid oxygen delivery decreased. Pediatr Pulmonol. 2009; 44:70–75. © 2008 Wiley‐Liss, Inc.

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“…However, in certain cases HFO will serve as the initial ventilation mode [20] . Observational and retrospective studies have reported that HFO as an initial ventilation mode may be an effective method to reduce mortality and chronic lung disease in children with CDH [7,[21][22][23][24] . So far, no prospective trials have been carried out to determine if initial ventilation treatment with HFO may reduce long-term pulmonary sequelae.…”

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confidence: 99%

Risk Factors for Chronic Lung Disease and Mortality in Newborns with Congenital Diaphragmatic Hernia

et al. 2010

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Background: Congenital diaphragmatic hernia (CDH) is associated with a mortality rate of 10–35% in live-born infants. Moreover, CDH survivors have a substantial risk of developing long-term pulmonary sequelae, such as bronchopulmonary dysplasia (BPD). Objectives: This study aims to evaluate risk factors associated with BPD and mortality in neonates with CDH, with particular focus on the initial ventilation mode. Methods: Eligible for inclusion were live-born infants with CDH born from 2001 through 2006 at the centers participating in the CDH Study Group. BPD (defined as oxygen dependency at day 30) and/or mortality by day 30 served as the primary endpoint. Results: A total of 2,078 neonates were included in the analysis. At day 30, 56% of the patients had either died or met the criteria for BPD. In infants who survived until day 30, the prevalence of BPD was 41%. The overall mortality rate was 31%. High-frequency oscillatory ventilation as initial ventilation mode, a right-sided defect, a prenatal diagnosis, a lower Apgar score at 5 min, a cardiac anomaly, a chromosomal anomaly and a lower gestational age were all associated with BPD and/or mortality by day 30. Conclusions: Despite improvements in neonatal care, the rates of BPD and early mortality in newborns with CDH are still considerable. Several important risk factors for a worse outcome are reported in this nonrandomized prospective observational study.

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Retrospective study of 111 cases of congenital diaphragmatic hernia treated with early high-frequency oscillatory ventilation and presurgical stabilization

Cited by 137 publications

References 24 publications

Predictors of survival in congenital diaphragmatic hernia patients requiring extracorporeal membrane oxygenation: CNMC 15-year experience

Predictors of survival in congenital diaphragmatic hernia patients requiring extracorporeal membrane oxygenation: CNMC 15-year experience

Sequential changes of hemodynamics and blood gases in newborn piglets with developing pneumothorax

Risk Factors for Chronic Lung Disease and Mortality in Newborns with Congenital Diaphragmatic Hernia

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