PREDICTION OF OUTCOME IN CONGENITAL DIAPHRAGMATIC-HERNIA

The case records of 59 patients with congenital diaphragmatic hernia ( CDH) who presented between 1984 and 1997 were studied retrospectively. Included in the study were infants born with CDH who required respira tory support within the first 6 h of life. Twenty-three were excluded from the study for various reasons; 36 were enrolled in the study; the male-to-female ratio was 18:18. Twenty-nine hernias were left-sided a nd 7 were right-sided. All patients were ventilated using conventional techniques. Arterial blood gases were measured on average 1.76 h foll owing admission and the initial period of resuscitation (range 1-4 h). Three formulae were applied in an attempt to predict outcome: ventila tion index against PCO2, alveolar-arterial oxygen gradient, and a newl y derived formula from this institution (Red Cross formula) that compr ises respiratory rate x PCO2 x FiO(2) x mean airway pressure/PaO2 x 60 00. Seventeen patients (47.2%) survived and 19 died (52.8%); 21 became stable enough to undergo surgery. The average time from presentation until surgery was 1.98 days (range 6 h to 4 days). The Red Cross formu la, with a 100% predictive value for mortality, 85% predictive value f or survival, and an overall predictive value of 91.6%, appeared to be superior to the other formulae studied. The availability of a highly a ccurate predictive formula may facilitate management of this frequentl y lethal disease.