Persistent hypercarbia after resuscitation is associated with increased mortality in congenital diaphragmatic hernia patients

Journal of Pediatric Surgery
Paulette I AbbasTimothy C Lee

Abstract

Within congenital diaphragmatic hernia (CDH) care, there have been attempts to identify clinical parameters associated with patient survival, including markers of postnatal pulmonary gas exchange. This study aimed to identify whether postnatal pulmonary gas exchange parameters correlated with CDH patient survival. A retrospective review was performed of isolated CDH neonates treated at a single institution from 1/2007 to 12/2013. Patient demographics, prenatal imaging, and postnatal clinical parameters, including arterial blood gas values within the first 24hours of life, were collected. Seventy-four patients with isolated CDH were identified. Fifty-seven had fetal MRI. Overall, 30-day patient survival was 85%. Sixteen infants (22%) required ECMO within 24hours. Mean initial PaCO2 in nonsurvivors was higher, and infants who remained hypercarbic postresuscitation (72±19mmHg) had a worse prognosis than those who resuscitated to a normal PaCO2 (39±1.6mmHg) (p<0.001). Prenatal fetal lung volumes measured by MRI were not strongly correlated with PaCO2 levels. CDH nonsurvivors are unable to maintain sufficient pulmonary gas exchange during the first 24hours of resuscitation. Furthermore, prenatal fetal lung volumes are weakly correla...Continue Reading

References

Oct 10, 1998·Journal of Pediatric Surgery·N N FinerW Ainsworth
Nov 3, 1998·Pediatric Surgery International·A NumanogluH Rode
Mar 6, 2007·Journal of Pediatric Surgery·Cynthia M SchultzUNKNOWN Congenital Diaphragmatic Hernia Study Group
Oct 16, 2013·Ultrasound in Obstetrics & Gynecology : the Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology·R RuanoO O Olutoye

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Citations

Sep 26, 2015·Pediatric Surgery International·Merrill McHoney
Aug 30, 2019·Archives of Disease in Childhood. Fetal and Neonatal Edition·Elizabeth E FogliaSarah J Ratcliffe
Nov 15, 2018·Journal of Perinatology : Official Journal of the California Perinatal Association·Minal J PatelUNKNOWN Congenital Diaphragmatic Hernia Study Group

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