title: Identifying neonates at a very high risk for mortality among children with congenital diaphragmatic hernia managed with extracorporeal membrane oxygenation.
abstract: OBJECTIVE
  The purpose of this study was to identify mortality risk factors in children with congenital diaphragmatic hernia (CDH) treated with extracorporeal membrane oxygenation (ECMO) and generate a prediction score for those at a very high risk for mortality.
  
  
  METHODS
  Data on first ECMO runs of all neonates with CDH, between January 1997 and June 2007, were obtained from the Extracorporeal Life Support Organization registry (N = 2678). The data were split into "training data (TD)" (n = 2006) and "validation data" (n = 672). The primary outcome analyzed was in-hospital mortality. Modified Poisson regression was used for analyses.
  
  
  RESULTS
  Overall in-hospital mortality among 2678 neonates (males, 57%; median age at ECMO, 1 day) was 52%. The univariate and multivariable analyses were performed using TD. An empirically weighted mortality prediction score was generated with possible scores ranging from 0 to 35 points. Of 69 who scored 14 or higher in the TD, 62 died (positive predictive value [PPV], 90%), of 37 with 15 or higher, 35 died (PPV, 95%), of 23 with 16 or higher, 22 died (PPV, 96%). A cut-off point of 15 was chosen and was tested using the separate validation dataset. In validation data, the cut-off point 15 had a PPV of 96% (23 died of 24).
  
  
  CONCLUSIONS
  Scoring 15 or higher on the prediction score identifies neonates with CDH at a very high risk for mortality among those managed with ECMO and could be used in surgical decision making and counseling.
authors.affiliation: Division of Pediatric Surgery, University of Alabama at Birmingham, AL 35233, USA.
authors.forename: Ramanath N
authors.initials: RN
authors.lastname: Haricharan
authors.forename: Douglas C
authors.initials: DC
authors.lastname: Barnhart
authors.forename: Hong
authors.initials: H
authors.lastname: Cheng
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Delzell
mesh_terms: D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006548:Hernia, Diaphragmatic / Q000401:mortality* / Q000628:therapy*; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D016012:Poisson Distribution; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012042:Registries; D012307:Risk Factors