Prognostic value of the oxygenation index to predict survival and timing of surgery in infants with congenital diaphragmatic hernia

Yew Wei Tan; Kamal Ali; Gwendolyn Andradi; Lekshmi Sasidharan; Anne Greenough; M Davenport

doi:10.1016/j.jpedsurg.2018.11.014

Prognostic value of the oxygenation index to predict survival and timing of surgery in infants with congenital diaphragmatic hernia

Yew Wei Tan, Kamal Ali, Gwendolyn Andradi, Lekshmi Sasidharan, Anne Greenough, M Davenport^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

19 Citations (Scopus)

Abstract

Aims: To compare the mean oxygenation index on day1 (MOId1) with the best OI on day1 (BOId1) in predicting 30-day mortality in congenital diaphragmatic hernia (CDH). In addition, to determine whether serial OIs in the first 48 h after birth and preoperative OI (PreOp-OI), were associated with optimal timing of surgery, ventilation requirement and hospital stay in infants with CDH. Methods: The medical records of infants with antenatally diagnosed CDH during 2009–2015 were retrospectively reviewed. Receiver operator characteristic curves were constructed to identify MOId1 and BOId1 cutoff levels to predict 30-day mortality. In those who underwent surgery, the mean OI on each of the first two days (MOId1, MOId2) and PreOp-OI were correlated using Spearman (rs) with the age at surgery, the duration of ventilation and length of stay. Statistical significance was P < 0.05* and < 0.001**. Results: Survivors (n = 44) and nonsurvivors (n = 24) were comparable in gestational age, birth weight and defect laterality. Nonsurvivors had higher median BOId1 (15.4 vs 2.9; P < 0.01) and MOId1 (48 vs 7.5; p < 0.01) than survivors. Mortality was best predicted by two cutoffs [BOId1 > 6 (sensitivity 92%, specificity 89%); and MOId1 > 17 (sensitivity 96%, specificity 96%)]. Forty-four infants underwent surgery at a median postnatal age of five (range 2–19) days. MOId1 and MOId2 both correlated significantly with the age at surgery (rs = 0.4** rs 0.5**) but not ventilation period and length of stay. PreOp-OI correlated significantly with age at surgery, duration of ventilation and length of stay (rs = 0.32* rs = 0.47** rs = 0.37*). A PreOp-OI < 3 was predictive of optimal timing for surgery with improved duration of ventilation (8 vs 22, P = 0.001) and length of stay (26 vs 47, P = 0.004). However, 11/44 (25%) patients would not achieve a PreOp-OI < 3 by day 7 + of life and might still require surgery, one of them died. Conclusion: Both MOId1 and BOId1 are highly predictive of mortality in CDH. Oxygenation indices in the first 48 h poorly predicted the timing of surgery. PreOp-OI < 3 may be a cutoff for optimal timing for surgery in infants for CDH repair. Type of study: Prognostic Study. Level of evidence: Level III.

Original language	English
Journal	Journal of Pediatric Surgery
Early online date	27 Dec 2018
DOIs	https://doi.org/10.1016/j.jpedsurg.2018.11.014
Publication status	E-pub ahead of print - 27 Dec 2018

Keywords

Congenital diaphragmatic hernia
Oxygenation index
Prognostic markers

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10.1016/j.jpedsurg.2018.11.014

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@article{5b8c6e9de6c2446cae5892d66c7191f8,

title = "Prognostic value of the oxygenation index to predict survival and timing of surgery in infants with congenital diaphragmatic hernia",

abstract = "Aims: To compare the mean oxygenation index on day1 (MOId1) with the best OI on day1 (BOId1) in predicting 30-day mortality in congenital diaphragmatic hernia (CDH). In addition, to determine whether serial OIs in the first 48 h after birth and preoperative OI (PreOp-OI), were associated with optimal timing of surgery, ventilation requirement and hospital stay in infants with CDH. Methods: The medical records of infants with antenatally diagnosed CDH during 2009–2015 were retrospectively reviewed. Receiver operator characteristic curves were constructed to identify MOId1 and BOId1 cutoff levels to predict 30-day mortality. In those who underwent surgery, the mean OI on each of the first two days (MOId1, MOId2) and PreOp-OI were correlated using Spearman (rs) with the age at surgery, the duration of ventilation and length of stay. Statistical significance was P < 0.05* and < 0.001**. Results: Survivors (n = 44) and nonsurvivors (n = 24) were comparable in gestational age, birth weight and defect laterality. Nonsurvivors had higher median BOId1 (15.4 vs 2.9; P < 0.01) and MOId1 (48 vs 7.5; p < 0.01) than survivors. Mortality was best predicted by two cutoffs [BOId1 > 6 (sensitivity 92%, specificity 89%); and MOId1 > 17 (sensitivity 96%, specificity 96%)]. Forty-four infants underwent surgery at a median postnatal age of five (range 2–19) days. MOId1 and MOId2 both correlated significantly with the age at surgery (rs = 0.4** rs 0.5**) but not ventilation period and length of stay. PreOp-OI correlated significantly with age at surgery, duration of ventilation and length of stay (rs = 0.32* rs = 0.47** rs = 0.37*). A PreOp-OI < 3 was predictive of optimal timing for surgery with improved duration of ventilation (8 vs 22, P = 0.001) and length of stay (26 vs 47, P = 0.004). However, 11/44 (25%) patients would not achieve a PreOp-OI < 3 by day 7 + of life and might still require surgery, one of them died. Conclusion: Both MOId1 and BOId1 are highly predictive of mortality in CDH. Oxygenation indices in the first 48 h poorly predicted the timing of surgery. PreOp-OI < 3 may be a cutoff for optimal timing for surgery in infants for CDH repair. Type of study: Prognostic Study. Level of evidence: Level III.",

keywords = "Congenital diaphragmatic hernia, Oxygenation index, Prognostic markers",

author = "Tan, {Yew Wei} and Kamal Ali and Gwendolyn Andradi and Lekshmi Sasidharan and Anne Greenough and M Davenport",

year = "2018",

month = dec,

day = "27",

doi = "10.1016/j.jpedsurg.2018.11.014",

language = "English",

journal = "Journal of Pediatric Surgery",

issn = "0022-3468",

publisher = "W.B. Saunders Ltd",

}

TY - JOUR

T1 - Prognostic value of the oxygenation index to predict survival and timing of surgery in infants with congenital diaphragmatic hernia

AU - Tan, Yew Wei

AU - Ali, Kamal

AU - Andradi, Gwendolyn

AU - Sasidharan, Lekshmi

AU - Greenough, Anne

AU - Davenport, M

PY - 2018/12/27

Y1 - 2018/12/27

N2 - Aims: To compare the mean oxygenation index on day1 (MOId1) with the best OI on day1 (BOId1) in predicting 30-day mortality in congenital diaphragmatic hernia (CDH). In addition, to determine whether serial OIs in the first 48 h after birth and preoperative OI (PreOp-OI), were associated with optimal timing of surgery, ventilation requirement and hospital stay in infants with CDH. Methods: The medical records of infants with antenatally diagnosed CDH during 2009–2015 were retrospectively reviewed. Receiver operator characteristic curves were constructed to identify MOId1 and BOId1 cutoff levels to predict 30-day mortality. In those who underwent surgery, the mean OI on each of the first two days (MOId1, MOId2) and PreOp-OI were correlated using Spearman (rs) with the age at surgery, the duration of ventilation and length of stay. Statistical significance was P < 0.05* and < 0.001**. Results: Survivors (n = 44) and nonsurvivors (n = 24) were comparable in gestational age, birth weight and defect laterality. Nonsurvivors had higher median BOId1 (15.4 vs 2.9; P < 0.01) and MOId1 (48 vs 7.5; p < 0.01) than survivors. Mortality was best predicted by two cutoffs [BOId1 > 6 (sensitivity 92%, specificity 89%); and MOId1 > 17 (sensitivity 96%, specificity 96%)]. Forty-four infants underwent surgery at a median postnatal age of five (range 2–19) days. MOId1 and MOId2 both correlated significantly with the age at surgery (rs = 0.4** rs 0.5**) but not ventilation period and length of stay. PreOp-OI correlated significantly with age at surgery, duration of ventilation and length of stay (rs = 0.32* rs = 0.47** rs = 0.37*). A PreOp-OI < 3 was predictive of optimal timing for surgery with improved duration of ventilation (8 vs 22, P = 0.001) and length of stay (26 vs 47, P = 0.004). However, 11/44 (25%) patients would not achieve a PreOp-OI < 3 by day 7 + of life and might still require surgery, one of them died. Conclusion: Both MOId1 and BOId1 are highly predictive of mortality in CDH. Oxygenation indices in the first 48 h poorly predicted the timing of surgery. PreOp-OI < 3 may be a cutoff for optimal timing for surgery in infants for CDH repair. Type of study: Prognostic Study. Level of evidence: Level III.

AB - Aims: To compare the mean oxygenation index on day1 (MOId1) with the best OI on day1 (BOId1) in predicting 30-day mortality in congenital diaphragmatic hernia (CDH). In addition, to determine whether serial OIs in the first 48 h after birth and preoperative OI (PreOp-OI), were associated with optimal timing of surgery, ventilation requirement and hospital stay in infants with CDH. Methods: The medical records of infants with antenatally diagnosed CDH during 2009–2015 were retrospectively reviewed. Receiver operator characteristic curves were constructed to identify MOId1 and BOId1 cutoff levels to predict 30-day mortality. In those who underwent surgery, the mean OI on each of the first two days (MOId1, MOId2) and PreOp-OI were correlated using Spearman (rs) with the age at surgery, the duration of ventilation and length of stay. Statistical significance was P < 0.05* and < 0.001**. Results: Survivors (n = 44) and nonsurvivors (n = 24) were comparable in gestational age, birth weight and defect laterality. Nonsurvivors had higher median BOId1 (15.4 vs 2.9; P < 0.01) and MOId1 (48 vs 7.5; p < 0.01) than survivors. Mortality was best predicted by two cutoffs [BOId1 > 6 (sensitivity 92%, specificity 89%); and MOId1 > 17 (sensitivity 96%, specificity 96%)]. Forty-four infants underwent surgery at a median postnatal age of five (range 2–19) days. MOId1 and MOId2 both correlated significantly with the age at surgery (rs = 0.4** rs 0.5**) but not ventilation period and length of stay. PreOp-OI correlated significantly with age at surgery, duration of ventilation and length of stay (rs = 0.32* rs = 0.47** rs = 0.37*). A PreOp-OI < 3 was predictive of optimal timing for surgery with improved duration of ventilation (8 vs 22, P = 0.001) and length of stay (26 vs 47, P = 0.004). However, 11/44 (25%) patients would not achieve a PreOp-OI < 3 by day 7 + of life and might still require surgery, one of them died. Conclusion: Both MOId1 and BOId1 are highly predictive of mortality in CDH. Oxygenation indices in the first 48 h poorly predicted the timing of surgery. PreOp-OI < 3 may be a cutoff for optimal timing for surgery in infants for CDH repair. Type of study: Prognostic Study. Level of evidence: Level III.

KW - Congenital diaphragmatic hernia

KW - Oxygenation index

KW - Prognostic markers

UR - http://www.scopus.com/inward/record.url?scp=85060148119&partnerID=8YFLogxK

U2 - 10.1016/j.jpedsurg.2018.11.014

DO - 10.1016/j.jpedsurg.2018.11.014

M3 - Article

AN - SCOPUS:85060148119

SN - 0022-3468

JO - Journal of Pediatric Surgery

JF - Journal of Pediatric Surgery

ER -

Prognostic value of the oxygenation index to predict survival and timing of surgery in infants with congenital diaphragmatic hernia

Abstract

Keywords

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