Tidal volumes at birth as predictor for adverse outcome in congenital diaphragmatic hernia
Mank,Arenda Carrasco Carrasco,Cristina Thio,Marta Clotet,Jordi Pauws,Steffen C. DeKoninck,Philip te Pas,Arjan B.
Mank,Arenda
Carrasco Carrasco,Cristina
Thio,Marta
Clotet,Jordi
Pauws,Steffen C.
DeKoninck,Philip
te Pas,Arjan B.
Abstract
Objective To assess the predictive value of tidal volume (Vt) of spontaneous breaths at birth in infants with congenital diaphragmatic hernia (CDH). Design Prospective study. Setting Tertiary neonatal intensive care unit. Patients Thirty infants with antenatally diagnosed CDH born at Hospital Sant Joan de Deu in Barcelona from September 2013 to September 2015. Interventions Spontaneous breaths and inflations given in the first 10 min after intubation at birth were recorded using respiratory function monitor. Only expired Vt of uninterrupted spontaneous breaths was included for analysis. Receiver operating characteristics (ROC) analysis was performed and the area under the curve (AUC) was estimated to assess the predictive accuracy of Vt. Main outcome measures Mortality before hospital discharge and chronic lung disease (CLD) at day 28 of life. Results There were 1.233 uninterrupted spontaneous breaths measured, and the overall mean Vt was 2.8 +/- 2.1 mL/kg. A lower Vt was found in infants who died (n=14) compared with survivors (n=16) (1.7 +/- 1.6 vs 3.7 +/- 2.1 mL/kg; p=0.008). Vt was lower in infants who died during admission or had CLD (n=20) compared with survivors without CLD (n=10) (2.0 +/- 1.7 vs 4.3 +/- 2.2 mL/kg; p=0.004). ROC analysis showed that Vt Conclusion Vt of spontaneous breaths measured immediately after birth is associated with mortality and CLD. Vt seems to be a reliable predictor but is not an independent predictor after adjustment for observed/expected lung to head ratio and liver position.
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Publisher Copyright: © Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ. Copyright: Copyright 2020 Elsevier B.V., All rights reserved.
Date
2020-05-01
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Keywords
FREQUENCY OSCILLATORY VENTILATION, TO-HEAD RATIO, PULMONARY-HYPERTENSION, LUNG HYPOPLASIA, EPIDEMIOLOGY, MANAGEMENT, FETUSES, INFANTS, SDG 3 - Good Health and Well-being
Citation
Mank, A, Carrasco Carrasco, C, Thio, M, Clotet, J, Pauws, S C, DeKoninck, P & te Pas, A B 2020, 'Tidal volumes at birth as predictor for adverse outcome in congenital diaphragmatic hernia', Archives of Disease in Childhood. Fetal and Neonatal Edition, vol. 105, no. 3, pp. F248-F252. https://doi.org/10.1136/archdischild-2018-316504