Does a highest pre-ductal O(2) saturation <85% predict non-survival for congenital diaphragmatic hernia?

J Perinatol. 2012 Dec;32(12):947-52. doi: 10.1038/jp.2012.18. Epub 2012 Mar 1.

Abstract

Objective: To analyze operative repair, extracorporeal membrane oxygenation (ECMO) and survival rates based on highest pre-ductal oxygen saturation (Pre-O(2)SAT) 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 PaO(2) and Pre-O(2)SAT in first 24 h of life. We excluded 614 infants due to severe anomaly. Pre-O(2)SAT data were available for 1672 infants.

Result: Among infants with highest Pre-O(2)SAT 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-O(2)SAT<85% who underwent operative repair. Of these, 83% (20/24) required ECMO support compared with 15% (144/961) of survivors with Pre-O(2)SAT>99% (P<0.001). The lowest reported Pre-O(2)SAT with survival was 32% and for survival without ECMO was 52%.

Conclusion: A reported highest Pre-O(2)SAT<85% in the first 24 h of life was not uniformly fatal; but survival of infants with Pre-O(2)SAT<85% was associated with high ECMO use and prolonged hospitalization.

Publication types

  • Comparative Study

MeSH terms

  • Cause of Death*
  • Cohort Studies
  • Combined Modality Therapy
  • Extracorporeal Membrane Oxygenation / methods*
  • Female
  • Hernia, Diaphragmatic / diagnosis
  • Hernia, Diaphragmatic / mortality
  • Hernia, Diaphragmatic / therapy
  • Hernias, Diaphragmatic, Congenital*
  • Humans
  • Infant, Newborn
  • Male
  • Oxygen / blood
  • Oxygen Consumption / physiology*
  • Predictive Value of Tests
  • Preoperative Care / methods
  • Registries
  • Regression Analysis
  • Respiratory Function Tests
  • Retrospective Studies
  • Risk Assessment
  • Severity of Illness Index
  • Survival Analysis
  • Time Factors

Substances

  • Oxygen