TY - JOUR
T1 - Prediction of survival in infants with congenital diaphragmatic hernia and the response to inhaled nitric oxide
AU - Arattu Thodika, Fahad
AU - Dimitrova, Svilena
AU - Nanjundappa, Mahesh
AU - Davenport, Mark
AU - Nicolaides, Kypros
AU - Dassios, Theodore
AU - Greenough, Anne
N1 - Funding Information:
This research was supported by the National Institute for Health Research (NIHR) Biomedical Research Centre at Guy’s and St Thomas’ NHS Foundation Trust and King’s College London. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.
Publisher Copyright:
© 2022, The Author(s).
PY - 2022/10
Y1 - 2022/10
N2 - The use of inhaled nitric oxide (iNO) in treating pulmonary hypertension in infants with congenital diaphragmatic hernia (CDH) is controversial. Our aims were to identify factors associated with survival in CDH infants and whether this was influenced by the response to iNO. Results of CDH infants treated in a tertiary surgical and medical perinatal centre in a ten year period (2011–2021) were reviewed. Factors affecting survival were determined. To assess the response to iNO, blood gases prior to and 30 to 60 min after initiation of iNO were analysed and PaO
2/FiO
2 ratios and oxygenation indices (OI) calculated. One hundred and five infants were admitted with CDH; 46 (43.8%) infants died. The CDH infants who died had a lower median observed to expected lung to head ratio (O/E LHR) (p < 0.001) and a higher median highest OI on day 1 (HOId1) (p < 0.001). HOId1 predicted survival after adjusting for gestational age, Apgar score at 5 min and O/E LHR (odds ratio 0.948 (95% confidence intervals 0.913–0.983)). Seventy-two infants (68.6%) received iNO; 28 survived to discharge. The median PaO
2 (46.7 versus 58.8 mmHg, p < 0.001) and the median PaO
2/FiO
2 ratio (49.4 versus 58.8, p = 0.003) improved post iNO initiation. The percentage change in the PaO
2/FiO
2 ratio post iNO initiation was higher in infants who survived (69.4%) compared to infants who died (10.2%), p = 0.018. Conclusion: The highest OI on day 1 predicted survival. iNO improved oxygenation in certain CDH infants and a positive response was more likely in those who survived.What is Known:• The use of iNO is controversial in infants with CDH with respect to whether it improves survival.What is New:• We have examined predictors of survival in CDH infants including the response to iNO and demonstrated that the highest oxygenation index on day 1 predicted survival (AUCROC =0.908).• Certain infants with CDH responded to iNO and those with a greater response were more likely to survive.
AB - The use of inhaled nitric oxide (iNO) in treating pulmonary hypertension in infants with congenital diaphragmatic hernia (CDH) is controversial. Our aims were to identify factors associated with survival in CDH infants and whether this was influenced by the response to iNO. Results of CDH infants treated in a tertiary surgical and medical perinatal centre in a ten year period (2011–2021) were reviewed. Factors affecting survival were determined. To assess the response to iNO, blood gases prior to and 30 to 60 min after initiation of iNO were analysed and PaO
2/FiO
2 ratios and oxygenation indices (OI) calculated. One hundred and five infants were admitted with CDH; 46 (43.8%) infants died. The CDH infants who died had a lower median observed to expected lung to head ratio (O/E LHR) (p < 0.001) and a higher median highest OI on day 1 (HOId1) (p < 0.001). HOId1 predicted survival after adjusting for gestational age, Apgar score at 5 min and O/E LHR (odds ratio 0.948 (95% confidence intervals 0.913–0.983)). Seventy-two infants (68.6%) received iNO; 28 survived to discharge. The median PaO
2 (46.7 versus 58.8 mmHg, p < 0.001) and the median PaO
2/FiO
2 ratio (49.4 versus 58.8, p = 0.003) improved post iNO initiation. The percentage change in the PaO
2/FiO
2 ratio post iNO initiation was higher in infants who survived (69.4%) compared to infants who died (10.2%), p = 0.018. Conclusion: The highest OI on day 1 predicted survival. iNO improved oxygenation in certain CDH infants and a positive response was more likely in those who survived.What is Known:• The use of iNO is controversial in infants with CDH with respect to whether it improves survival.What is New:• We have examined predictors of survival in CDH infants including the response to iNO and demonstrated that the highest oxygenation index on day 1 predicted survival (AUCROC =0.908).• Certain infants with CDH responded to iNO and those with a greater response were more likely to survive.
UR - http://www.scopus.com/inward/record.url?scp=85138839137&partnerID=8YFLogxK
U2 - 10.1007/s00431-022-04568-8
DO - 10.1007/s00431-022-04568-8
M3 - Article
SN - 0340-6199
VL - 181
SP - 3683
EP - 3689
JO - European Journal of Pediatrics
JF - European Journal of Pediatrics
IS - 10
ER -