The value of Pa(CO2) in relation to outcome in congenital diaphragmatic hernia.

Abstract:

BACKGROUND:Postnatal assessment of disease severity is critical for analysis of mortality rates and development of future interventions in congenital diaphragmatic hernia (CDH). OBJECTIVE:The objective of this study was to stratify the risk of mortality based on arterial Paco 2. METHODS:Retrospective analysis of infants (n = 133) with CDH admitted to a regional extracorporeal membrane oxygenation (ECMO) center in two different periods: period I (1987-1996; n = 46) and period II (2002-2010; n = 87). RESULTS:The mortality rate (37%) was similar in both periods (p = 0.98). Paco 2 < 60 mm Hg in the first arterial blood gas (ABG) was an independent predictor of survival in both periods (p = 0.03). The predicted survival rate was 84% if initial Paco 2 was < 55 mm Hg. For infants with initial Paco 2 > 55 mm Hg treated with ECMO (n = 83), the predicted survival rate was 11% if the Paco 2 was > 88 mm Hg before the initiation of ECMO. CONCLUSION:Paco 2, a surrogate of lung hypoplasia, may be useful for risk stratification in CDH. Paco 2 < 60 mm Hg in the first ABG may indicate milder pulmonary hypoplasia. A Paco 2 > 80 mm Hg in the first ABG and/or before ECMO may indicate severe pulmonary hypoplasia.

journal_name

Am J Perinatol

authors

Salas AA,Bhat R,Dabrowska K,Leadford A,Anderson S,Harmon CM,Ambalavanan N,El-Ferzli GT

doi

10.1055/s-0034-1368088

subject

Has Abstract

pub_date

2014-11-01 00:00:00

pages

939-46

issue

11

eissn

0735-1631

issn

1098-8785

journal_volume

31

pub_type

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