PERIOPERATIVE ASSESSMENT OF RESPIRATORY COMPLIANCE AND LUNG-VOLUME ININFANTS WITH CONGENITAL DIAPHRAGMATIC-HERNIA - PREDICTION OF OUTCOME

Background/Purpose: Infants who have congenital diaphragmatic hernia ( CDH) have high mortality and morbidity. The aim of this study was to d etermine the relative ability of the results of serial measurements of compliance of the respiratory system (CRS) end lung volume (functiona l residual capacity (FRC)) to predict poor outcome: death or oxygen de pendency at 28 days. In addition, the authors wished to document the e volution of any lung function abnormalities during the perioperative p eriod. Methods: Daily measurements of CRS and FRC were made in the fir st week of life and subsequently during week 2 in 16 infants who had a median gestational age of 38 weeks and birth weight of 3.2 kg. Result s: Seven infants had a poor outcome: five died a nd two others remaine d oxygen dependent beyond 28 days. The infants who had a poor outcome were characterized on day 1 by a significantly lower CRS, but not FRC (P<.05). In comparison with results from day 1, the median CRS of the infants overall had significantly improved only by week 2 (P<.05), the re was no such significant change in FRC with increasing postnatal age . At week 2, only the CRS results differed significantly between those infants who had and who did not have poor outcome (P<.05). Conclusion : The results of serial measurements df CRS, rather than FRC are the m ore useful predictor of outcome in infants who have CDH. Copyright (C) 1997 by W.B. Saunders Company.