J Korean Med Sci.  2013 Jun;28(6):924-928. 10.3346/jkms.2013.28.6.924.

A Simplified Formula Using Early Blood Gas Analysis Can Predict Survival Outcomes and the Requirements for Extracorporeal Membrane Oxygenation in Congenital Diaphragmatic Hernia

• Park HW
• Lee BS
• Lim G
• Choi YS
• Kim EA
• Kim KS

• KMID: 2158042
• DOI: http://doi.org/10.3346/jkms.2013.28.6.924

Abstract

The aims of this study were to investigate whether early arterial blood gas analysis (ABGA) could define the severity of disease in infants with congenital diaphragmatic hernia (CDH). We conducted a retrospective study over a 21-yr period of infants diagnosed with CDH. Outcomes were defined as death before discharge, and extracorporeal membrane oxygenation requirements (ECMO) or death. A total 114 infants were included in this study. We investigated whether simplified prediction formula [PO2-PCO2] values at 0, 4, 8, and 12 hr after birth were associated with mortality, and ECMO or death. The area under curve (AUC) of receiver operating characteristic curve was used to determine the optimum ABGA values for predicting outcomes. The value of [PO2-PCO2] at birth was the best predictor of mortality (AUC 0.803, P < 0.001) and at 4 hr after birth was the most reliable predictor of ECMO or death (AUC 0.777, P < 0.001). The value of [PO2-PCO2] from ABGA early period after birth can reliably predict outcomes in infants with CDH.

Keyword

Congenital Diaphragmatic Hernia; Mortality; Extracorporeal Membrane Oxygenation; Infant, Newborn

MeSH Terms

*Algorithms
Area Under Curve
*Blood Gas Analysis
*Extracorporeal Membrane Oxygenation
Female
Hernia, Diaphragmatic/*congenital/mortality/physiopathology
Humans
Infant, Newborn
Male
Predictive Value of Tests
ROC Curve
Retrospective Studies
Survival Rate
Treatment Outcome

Figure

• 

  Fig. 1 Comparison of receiver operating characteristic (ROC) curves the simplified prediction formula at birth with the CDHSG formula in the prediction of mortality outcomes in congenital diaphragmatic hernia. The simplified prediction formula at birth (initial [PaO2-PaCO2], AUC 0.803) showed better discrimination than the CDHSG formula (AUC 0.740) in the prediction of mortality outcomes with higher area under curve (AUC) value of ROC curve.

• 

  Fig. 2 Comparison of receiver operating characteristic (ROC) curves for the CDHSG formula with those for the simplified prediction formula at 4, 8, and 12 hr post-birth in predicting extracorporeal membrane oxygenation (ECMO) or death outcome in congenital diaphragmatic hernia. Based on ROC curve, the [PaO2-PaCO2] at 4 hr had the highest area under curve (AUC) (0.777) and Congenital Diaphragmatic Hernia Study Group (CDHSG) prediction formula had the lowest AUC (0.759) in predicting ECMO or death outcome.

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