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Lowest PaCO2 on the first day of life predicts mortality and morbidity among infants with congenital diaphragmatic hernia

Journal of Perinatology volume 39, pages 229–236 (2019)Cite this article

Subjects

Abstract

Objective:

To evaluate the association between hypercarbia in the first 24 h of life and clinical outcomes in infants with congenital diaphragmatic hernia (CDH).

Study design:

Retrospective review of patients entered into the CDHSG registry between 2007–2014. Half of the identified patients were analyzed to identify the PaCO2 value most predictive of mortality. Prediction models for outcomes of death, ECMO, and respiratory support at 30 days of life (DOL) were developed using PaCO2. Remaining half of data was used for validation of study findings.

Results:

1878 and 1875 patients were analyzed in the testing and validation groups. Lowest PaCO2≥60 mmHg in the first DOL is highly predictive of death prior to discharge. Prediction models including this variable demonstrate good discrimination for outcomes of death, ECMO, and respiratory support (AUC 0.8808, 0.8279, 0.8065).

Conclusion:

Lowest PaCO2 in the first DOL is an independent risk factor of mortality and morbidity in CDH.

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Authors and Affiliations

  1. Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas McGovern Medical School, Houston, TX, USA

    Minal J. Patel & Lakshmi I. Katakam

  2. Division of Nephrology and Hypertension, Department of Pediatrics, University of Texas McGovern Medical School, Houston, TX, USA

    Cynthia S. Bell

  3. Department of Pediatric Surgery, University of Texas McGovern Medical School and Children’s Memorial Hermann Hospital, Houston, TX, USA

    Kevin P. Lally & Pamela A. Lally

  4. Center for Surgical Trials and Evidenced-Based Practice (CSTEP), University of Texas McGovern Medical School, Houston, TX, USA

    Kevin P. Lally & Pamela A. Lally

Authors
  1. Minal J. Patel
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  2. Cynthia S. Bell
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  5. Lakshmi I. Katakam
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for the Congenital Diaphragmatic Hernia Study Group

Contributions

Minal Patel conceptualized the study, performed some statistical analysis, drafted the initial manuscript, and reviewed and revised the manuscript. Cynthia Bell developed a detailed statistical plan, performed expert statistical analysis, provided guidance with data interpretation, and revised the manuscript. Kevin Lally provided oversight on study design and critically reviewed the manuscript. Pamela Lally coordinated and supervised data collection in the Congenital Diaphragmatic Hernia Study Group database, provided data output for the study, and critically reviewed the manuscript. Lakshmi Katakam conceptualized the study, provided oversight on study design, and critically reviewed and revised the manuscript. All authors approved the final manuscript as submitted.

Corresponding author

Correspondence to Minal J. Patel.

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The authors declare that they have no conflict of interest.

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Patel, M.J., Bell, C.S., Lally, K.P. et al. Lowest PaCO2 on the first day of life predicts mortality and morbidity among infants with congenital diaphragmatic hernia. J Perinatol 39, 229–236 (2019). https://doi.org/10.1038/s41372-018-0269-6

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  • DOI: https://doi.org/10.1038/s41372-018-0269-6

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