title: Persistent hypercarbia after resuscitation is associated with increased mortality in congenital diaphragmatic hernia patients.
abstract: BACKGROUND
  Within congenital diaphragmatic hernia (CDH) care, there have been attempts to identify clinical parameters associated with patient survival, including markers of postnatal pulmonary gas exchange. This study aimed to identify whether postnatal pulmonary gas exchange parameters correlated with CDH patient survival.
  
  
  METHODS
  A retrospective review was performed of isolated CDH neonates treated at a single institution from 1/2007 to 12/2013. Patient demographics, prenatal imaging, and postnatal clinical parameters, including arterial blood gas values within the first 24hours of life, were collected.
  
  
  RESULTS
  Seventy-four patients with isolated CDH were identified. Fifty-seven had fetal MRI. Overall, 30-day patient survival was 85%. Sixteen infants (22%) required ECMO within 24hours. Mean initial PaCO2 in nonsurvivors was higher, and infants who remained hypercarbic postresuscitation (72±19mmHg) had a worse prognosis than those who resuscitated to a normal PaCO2 (39±1.6mmHg) (p<0.001). Prenatal fetal lung volumes measured by MRI were not strongly correlated with PaCO2 levels.
  
  
  CONCLUSIONS
  CDH nonsurvivors are unable to maintain sufficient pulmonary gas exchange during the first 24hours of resuscitation. Furthermore, prenatal fetal lung volumes are weakly correlated with actual pulmonary gas exchange. These data may be useful for patient counseling during the resuscitative phase of CDH care.
authors.affiliation: Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX, USA; Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Paulette I
authors.initials: PI
authors.lastname: Abbas
authors.affiliation: Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX, USA; Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA; Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Darrell L
authors.initials: DL
authors.lastname: Cass
authors.affiliation: Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX, USA; Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA; Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Oluyinka O
authors.initials: OO
authors.lastname: Olutoye
authors.affiliation: Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX, USA; Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Irving J
authors.initials: IJ
authors.lastname: Zamora
authors.affiliation: Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX, USA; Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Adesola C
authors.initials: AC
authors.lastname: Akinkuotu
authors.affiliation: Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX, USA; Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Fariha
authors.initials: F
authors.lastname: Sheikh
authors.affiliation: Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX, USA; Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Welty
authors.affiliation: Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX, USA; Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA. Electronic address: tclee@texaschildrens.org.
authors.forename: Timothy C
authors.initials: TC
authors.lastname: Lee
mesh_terms: D005260:Female; D065630:Hernias, Diaphragmatic, Congenital / Q000401:mortality / Q000601:surgery*; D006801:Humans; D006935:Hypercapnia / Q000209:etiology* / Q000401:mortality; D007223:Infant; D007226:Infant Mortality / Q000639:trends; D007231:Infant, Newborn; D008297:Male; D012151:Resuscitation / Q000009:adverse effects* / Q000379:methods; D012189:Retrospective Studies; D013781:Texas / Q000453:epidemiology
keywords: Arterial blood gas; Congenital diaphragmatic hernia; Hypercarbia; Mortality; Prenatal imaging