Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Letter to the Editor
  • Published:

Pre-ECMO Predictors of Nonsurvival in Congenital Diaphragmatic Hernia

Journal of Perinatology volume 22, pages 682–683 (2002)Cite this article

We read with great interest the article, “A statistical model to predict nonsurvival in congenital diaphragmatic hernia,” by Springer et al.1

A noninvasive bedside measurement that would predict nonsurvivors with congenital diaphragmatic hernia (CDH) pre-ECMO has been elusive. It has been shown, on living and postmortem CDH lungs, that there is a critical lung volume below which a very high mortality is predicted.2,3 Pulmonary hypoplasia is associated with a hypoplastic vascular bed that leads to pulmonary hypertension, which has structural and functional components. ECMO effectively reverses the functional hypertension and initiates vascular remodeling, but does not significantly alter the structural hypoplastic component associated with pulmonary hypoplasia.3 Baumgart et al.4 have shown that in CDH with severe pulmonary hypoplasia, the fetal heart is malpositioned and there is redistribution of fetal cardiac output, which may result in left ventricular hypoplasia. This suggests that the maldevelopment of the left ventricle may not only mirror the severity of pulmonary hypoplasia with CDH, but may have an independent influence on outcome. Suda et al.,5 using echocardiographic measurements of the ratio of the added diameters of hilar left and right pulmonary arteries to the diameter of descending aorta, noted that ratios <1.3 predicted CDH mortality with a sensitivity of 85% and specificity of 100%. This ratio may be a function of lung and vascular hypoplasia as well as fetal redistribution of left cardiac output. Springer et al.1 calculated left ventricular mass (LVMASS) and fractional shortening (FS) of left ventricles from echocardiographic measurements, prior to CDH surgical repair. Using the equation LVMASS×FS1/2, they showed that an index of <1.2 was associated with nonsurvival, despite maximal intervention.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

References

  1. Springer SC, Fleming D, Hulsey TC . A statistical model to predict nonsurvival in congenital diaphragmatic hernia J Perinatol 2002 22: 263–7

    Article  Google Scholar 

  2. Antunes MJ, Greenspan JS, Cullen JA, Holt WJ, Baumgart S, Spitzer AR . Prognosis with preoperative pulmonary function and lung volume assessment in infants with congenital diaphragmatic hernia Pediatrics 1995 96: 1117–22

    CAS  Google Scholar 

  3. Thibeault DW, Haney B . Lung volume, pulmonary vasculature, and factors affecting survival in congenital diaphragmatic hernia Pediatrics 1998 101: 289–95

    Article  CAS  Google Scholar 

  4. Baumgart S, Paul JJ, Hubta JC et al. Cardiac malposition, redistribution of fetal cardiac output, and left heart hypoplasia reduce survival in neonates with congenital diaphragmatic hernia requiring extracorporeal membrane oxygenation J Pediatr 1998 133: 57–62

    Article  CAS  Google Scholar 

  5. Suda K, Bigras JL, Bohn D, Hornberger LK, McCrindle BW . Echocardiographic predictors of outcome in newborns with congenital diaphragmatic hernia Pediatrics 2000 105: 1106–9

    Article  CAS  Google Scholar 

  6. Wyatt HL, Heng MK, Meerbaum S et al. Cross-sectional, echocardiography: I. Analysis of mathematic models for quantifying mass of the left ventricle in dogs Circulation 1979 60: 1104–13

    Article  CAS  Google Scholar 

  7. Olsen SL, Thibeault DW, Truog WE . Crossover trial comparing pressure support with synchronized intermittent mandatory ventilation J Perinatol 2002 22: 461–6

    Article  Google Scholar 

  8. Berglund G, Karlberg P . Determination of the functional residual capacity in newborn infants Acta Paediatr 1956 45: 541–4

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Section of Neonatology, Children's Mercy Hospital and Clinics, Kansas City, MO, USA

    Donald W Thibeault MD, Steven L Olsen MD & William E Truog MD

  2. Section of Cardiology, Children's Mercy Hospital and Clinics, Kansas City, MO, USA

    Marius M Hubbell MD

Authors
  1. Donald W Thibeault MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Steven L Olsen MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. William E Truog MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Marius M Hubbell MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Thibeault, D., Olsen, S., Truog, W. et al. Pre-ECMO Predictors of Nonsurvival in Congenital Diaphragmatic Hernia. J Perinatol 22, 682–683 (2002). https://doi.org/10.1038/sj.jp.7210828

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.jp.7210828

Search

Advanced search

Quick links