Prognostic indicators of survival in infants with congenital diaphragmatichernia

Purpose: This study sought to identify the factors predictive of the short- term outcome in infants with congenital diaphragmatic hernia (CDH). Methods We retrospectively reviewed medical records from September 1985 to December 1998 for all infants born with CDH and managed at National Taiwan University Hospital (NTUH). Coexisting pathology and measures of respirator y function were analyzed to determine the prognostic factors. Results: A total of 32 infants with CDH were managed at NTUH over the past 13 years. The investigated factors associated with poor prognosis in CDH in cluded congenital heart disease, chromosomal abnormality, pneumothorax, and preoperative parameters including arterial partial carbon dioxide pressure greater than 40 mmHg, arterial partial oxygen pressure less than 100 mmHg, alveolo-arterial partial oxygen pressure greater than 610 mmHg, and oxygen index (OI) greater than 0.4. Multiple logistic regression analyses indicat ed that only an OI greater than 0.4 and pneumothorax were significant indic ators of poor prognosis. When the incidence of pneumothorax was compared be tween patients who received ventilation using a conventional mechanical ven tilator or high-frequency oscillatory ventilator (HFOV), a trend toward a l ower incidence of pneumothorax in those using HFOV for initial stabilizatio n was found (p = 0.08). Conclusions: An OI greater than 0.4 before surgery and pneumothorax are poo r prognostic indicators in infants with CDH. A high OI is reflective of the severity of pulmonary dysfunction in infants. Pneumothorax further comprom ises the dysfunction of a hypoplastic lung in infants with CDH. The results of this study show the importance of avoiding iatrogenic pneumothorax duri ng management of infants with CDH.