title: Pulmonary support on day 30 as a predictor of morbidity and mortality in congenital diaphragmatic hernia.
abstract: OBJECTIVE
  Congenital diaphragmatic hernia (CDH) is associated with significant in-hospital mortality, morbidity and length-of-stay (LOS). We hypothesized that the degree of pulmonary support on hospital day-30 may predict in-hospital mortality, LOS, and discharge oxygen needs and could be useful for risk prediction and counseling.
  
  
  METHODS
  862 patients in the CDH Study Group registry with a LOS ≥ 30 days were analyzed (2007-2010). Pulmonary support was defined as (1) room-air (n=320) (2) noninvasive supplementation (n=244) (3) mechanical ventilation (n=279) and (4) extracorporeal membrane oxygenation (ECMO, n=19). Cox Proportional hazards and logistic regression models were used to determine the case-mix adjusted association of oxygen requirements on day-30 with mortality and oxygen requirements at discharge.
  
  
  RESULTS
  On multivariate analysis, use of ventilator (HR 5.1, p=.003) or ECMO (HR 19.6, p<.001) was a significant predictor of in-patient mortality. Need for non-invasive supplementation or ventilator on day-30 was associated with a respective 22-fold (p<.001) and 43-fold (p<.001) increased odds of oxygen use at discharge compared to those on room-air.
  
  
  CONCLUSIONS
  Pulmonary support on Day-30 is a strong predictor of length of stay, oxygen requirements at discharge and in-patient mortality and may be used as a simple prognostic indicator for family counseling, discharge planning, and identification of high-risk infants.
authors.affiliation: Department of Surgery, Boston Children's Hospital, Boston, MA 02115, USA.
authors.forename: Ryan P
authors.initials: RP
authors.lastname: Cauley
authors.forename: Alexander
authors.initials: A
authors.lastname: Stoffan
authors.forename: Kristina
authors.initials: K
authors.lastname: Potanos
authors.forename: Nora
authors.initials: N
authors.lastname: Fullington
authors.forename: Dionne A
authors.initials: DA
authors.lastname: Graham
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Finkelstein
authors.forename: Heung Bae
authors.initials: HB
authors.lastname: Kim
authors.forename: Jay M
authors.initials: JM
authors.lastname: Wilson
mesh_terms: D015331:Cohort Studies; D003661:Decision Support Techniques; D006548:Hernia, Diaphragmatic / Q000401:mortality / Q000628:therapy; D065630:Hernias, Diaphragmatic, Congenital; D017052:Hospital Mortality; D006801:Humans; D007231:Infant, Newborn; D007902:Length of Stay / Q000706:statistics & numerical data*; D016015:Logistic Models; D011379:Prognosis; D016016:Proportional Hazards Models; D012042:Registries; D012138:Respiratory Therapy / Q000379:methods / Q000401:mortality*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors
keywords: Congenital anomaly; Extracorporeal membrane oxygenation; Mechanical ventilation; Risk assessment