Oxygenation Index and Oxygen Saturation Index in Congenital Diaphragmatic Hernia: Do Management Guidelines Make a Difference?

Tanner S Ellsworth; Ryan J Carpenter; Christian C Yost; Bradley A Yoder; Michelle J Yang

doi:10.1159/000550139

Oxygenation Index and Oxygen Saturation Index in Congenital Diaphragmatic Hernia: Do Management Guidelines Make a Difference?

Neonatology. 2025 Dec 22:1-9. doi: 10.1159/000550139. Online ahead of print.

Authors

Tanner S Ellsworth¹, Ryan J Carpenter^{1

2}, Christian C Yost^{1

3}, Bradley A Yoder¹, Michelle J Yang⁴

Affiliations

¹ Divisions of Neonatology, University of Utah School of Medicine and Primary Children's Hospital, Intermountain Healthcare Salt Lake City, Salt Lake City, Utah, USA.
² Pediatric Cardiology, University of Utah School of Medicine and Primary Children's Hospital, Intermountain Healthcare Salt Lake City, Salt Lake City, Utah, USA.
³ Molecular Medicine Program, University of Utah School of Medicine and Primary Children's Hospital, Intermountain Healthcare Salt Lake City, Salt Lake City, Utah, USA.
⁴ Divisions of Neonatology, University of Utah School of Medicine and Primary Children's Hospital, Intermountain Healthcare Salt Lake City, Salt Lake City, Utah, USA, michelle.yang@hsc.utah.edu.

Abstract

Introduction: The aim of this study was to correlate oxygenation index (OI) and oxygen saturation index (OSI) in congenital diaphragmatic hernia (CDH) and determine the impact of guideline changes from two different epochs.

Methods: Retrospective analysis of 390 CDH neonates managed at University of Utah/Primary Children's Hospitals from 2003 to 2024. We performed regression analysis for paired OI and OSI values over the first week of life (2,604 pairs), comparing pre- (2003-2015) and post- (2016-2024) epoch effects of a 2016 CDH guideline. We analyzed predictive abilities for OI and OSI within and between epochs for extracorporeal membrane oxygenation (ECMO) and/or death.

Results: OI and OSI showed higher correlation in the post- (R2 = 0.755) vs. pre-epoch (R2 = 0.650). Between epochs analysis demonstrated lower inspired oxygen, mean airway pressure, arterial oxygen pressure, OI, and OSI in the post-epoch. ECMO use was lower in post-epoch (9.8% vs. 33%), but pre-ECMO OI and OSI were similar between epochs. Classification of severe lung dysfunction by OI >25 or OSI >12 showed similar abilities to predict ECMO and/or death.

Discussion: OI and OSI were highly correlated in CDH but affected by variation in CDH management. OSI classified severity of cardiopulmonary dysfunction as effectively as OI.

Keywords: Congenital diaphragmatic hernia; Extracorporeal membrane oxygenation; Outcome prediction; Oxygen saturation index; Oxygenation index.