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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
.
Diseases
Validation
Diseases presenting
"neonatal care"
symptom
congenital diaphragmatic hernia
dystrophic epidermolysis bullosa
harlequin ichthyosis
lamellar ichthyosis
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