Role of admission gas exchange measurement in predicting congenital diaphragmatic hernia survival in the era of gentle ventilation.

[congenital diaphragmatic hernia]

Neonates with significant congenital diaphragmatic hernia (CDH ) require cardiopulmonary support . Management has been characterized by progressive abandonment of hyperventilation . Ability to prognosticate outcomes using measures of ventilation and oxygenation with gentle ventilation remains unclear . We sought to determine whether assessment of gas exchange at the time of NICU admission is predictive of survival in this current era .Neonates with CDH admitted to a Children 's Hospital from 1995 to 2006 were evaluated for demographics , blood gas (ABG ) measurements and ventilator settings for the first 48 hours , and discharge outcome .One -hundred -and-nineteen CDH patients were admitted , 88 (74 %) survived . Mean admission ABG pCO 2 was higher in infants who died compared to survivors (86 ±48 versus 49 ±20 , p ≤0 .001 ); positive predictive value (PPV ) for mortality of pCO 2 ≥80 mmHg was 0 .71 . Mean first hour preductal oxygen saturation (preductalO 2 Sat ) was lower in infants who died compared to survivors (81 ±17 versus 97 ±5 , p <0 .001 ); PPV for mortality of preductalO 2 Sat <85 % was 0 .82 . Eleven patients met both pCO 2 and preductalO 2 Sat criteria , and 10 (91 %) died , PPV of 0 .92 . Within hours of admission , pCO 2 and preductalO 2 Sat differences between survivors and nonsurvivors lost significance .Admission pCO 2 and preductalO 2 Sat may be useful in predicting survival in neonatal CDH . The differential in gas exchange between survivors and nonsurvivors loses significance with contemporary neonatal care .