title: First 24-h SNAP-II score and highest PaCO2 predict the need for ECMO in congenital diaphragmatic hernia.
abstract: OBJECTIVE
  Early clinical predictors for the use of ECMO in patients with congenital diaphragmatic hernia (CDH) are lacking. We sought to evaluate the first 24-h SNAP-II score and highest PaCO2 as predictors of ECMO support and in-hospital mortality in neonates with CDH.
  
  
  METHODS
  Retrospective review of 47 consecutive neonates with CDH admitted to our institution from January 2007 to December 2010 was performed. Covariates of ECMO use including SNAP-II score and highest PaCO2 within the first 24 h of NICU admission were evaluated.
  
  
  RESULTS
  Of the 47 infants in this study, 24 patients were supported with ECMO. The ECMO group had a higher incidence of pulmonary hypertension, higher PaCO2, and higher 24-h SNAP-II scores. Only the SNAP-II score and not highest PaCO2 predicted mortality following multivariate adjustment.
  
  
  CONCLUSIONS
  The first 24-h SNAP-II score and highest PaCO2 may provide some prognostic value in identifying neonates who undergo ECMO support; however neither measure was independently associated with the use of therapy. Only the SNAP-II score was associated with in-hospital mortality following multivariate adjustment. Additional study is needed to validate these results in a larger data set.
authors.affiliation: Department of Neonatology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA.
authors.forename: Alana J
authors.initials: AJ
authors.lastname: Coleman
authors.forename: Beverly
authors.initials: B
authors.lastname: Brozanski
authors.forename: Burhan
authors.initials: B
authors.lastname: Mahmood
authors.forename: Peter D
authors.initials: PD
authors.lastname: Wearden
authors.forename: Douglas
authors.initials: D
authors.lastname: Potoka
authors.forename: Bradley A
authors.initials: BA
authors.lastname: Kuch
mesh_terms: D015415:Biomarkers; D002245:Carbon Dioxide / Q000097:blood*; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D005865:Gestational Age; D006548:Hernia, Diaphragmatic / Q000097:blood / Q000150:complications / Q000401:mortality / Q000628:therapy; D065630:Hernias, Diaphragmatic, Congenital; D017052:Hospital Mortality; D006801:Humans; D006935:Hypercapnia / Q000097:blood / Q000209:etiology; D006976:Hypertension, Pulmonary / Q000097:blood / Q000209:etiology; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D008176:Lung Volume Measurements; D008297:Male; D010313:Partial Pressure; D012372:ROC Curve; D012189:Retrospective Studies; D012720:Severity of Illness Index
chemical_list: D015415:Biomarkers; D002245:Carbon Dioxide
keywords: Congenital diaphragmatic hernia; Extracorporeal membrane oxygenation; SNAP-II score