title: The value of Pa(CO2) in relation to outcome in congenital diaphragmatic hernia.
abstract: BACKGROUND
  Postnatal assessment of disease severity is critical for analysis of mortality rates and development of future interventions in congenital diaphragmatic hernia (CDH).
  
  
  OBJECTIVE
  The objective of this study was to stratify the risk of mortality based on arterial Paco 2.
  
  
  METHODS
  Retrospective analysis of infants (n = 133) with CDH admitted to a regional extracorporeal membrane oxygenation (ECMO) center in two different periods: period I (1987-1996; n = 46) and period II (2002-2010; n = 87).
  
  
  RESULTS
  The mortality rate (37%) was similar in both periods (p = 0.98). Paco 2 < 60 mm Hg in the first arterial blood gas (ABG) was an independent predictor of survival in both periods (p = 0.03). The predicted survival rate was 84% if initial Paco 2 was < 55 mm Hg. For infants with initial Paco 2 > 55 mm Hg treated with ECMO (n = 83), the predicted survival rate was 11% if the Paco 2 was > 88 mm Hg before the initiation of ECMO.
  
  
  CONCLUSIONS
  Paco 2, a surrogate of lung hypoplasia, may be useful for risk stratification in CDH. Paco 2 < 60 mm Hg in the first ABG may indicate milder pulmonary hypoplasia. A Paco 2 > 80 mm Hg in the first ABG and/or before ECMO may indicate severe pulmonary hypoplasia.
authors: Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama.
authors: Ariel A
authors: AA
authors: Salas
authors: Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama.
authors: Ramachandra
authors: R
authors: Bhat
authors: Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama.
authors: Katarzyna
authors: K
authors: Dabrowska
authors: Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama.
authors: Alicia
authors: A
authors: Leadford
authors: Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama.
authors: Scott
authors: S
authors: Anderson
authors: Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama.
authors: Carroll M
authors: CM
authors: Harmon
authors: Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama.
authors: Namasivayam
authors: N
authors: Ambalavanan
authors: Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama.
authors: George T
authors: GT
authors: El-Ferzli
mesh_terms: D002245:Carbon Dioxide / Q000097:blood*; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D065630:Hernias, Diaphragmatic, Congenital / Q000097:blood* / Q000401:mortality* / Q000628:therapy; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis
chemical_list: D002245:Carbon Dioxide