title: Survival prediction of high-risk outborn neonates with congenital diaphragmatic hernia from capillary blood gases.
abstract: The extent of lung hypoplasia in neonates with congenital diaphragmatic hernia (CDH) can be assessed from gas exchange. We examined the role of preductal capillary blood gases in prognosticating outcome in patients with CDH.
  
  
  
  We retrospectively reviewed demographic data, disease characteristics, and preductal capillary blood gases on admission and within 24 h following admission for 44 high-risk outborn neonates. All neonates were intubated after delivery due to acute respiratory distress, and were emergently transferred via ground ambulance to our unit between 1/2000 and 12/2014. The main outcome measure was survival to hospital discharge and explanatory variables of interest were preductal capillary blood gases obtained on admission and during the first 24 h following admission.
  
  
  
  Higher ratio of preductal partial pressure of oxygen to fraction of inspired oxygen (PcO2/FIO2) on admission predicted survival (AUC = 0.69, P = 0.04). However, some neonates substantially improve PcO2/FIO2 following initiation of treatment. Among neonates who survived at least 24 h, the highest preductal PcO2/FIO2 achieved in the initial 24 h was the strongest predictor of survival (AUC = 0.87, P = 0.002). Nonsurvivors had a mean admission preductal PcCO2 higher than survivors (91 ± 31 vs. 70 ± 25 mmHg, P = 0.02), and their PcCO2 remained high during the first 24 h of treatment.
  
  
  
  The inability to achieve adequate gas exchange within 24 h of initiation of intensive care treatment is an ominous sign in high-risk outborn neonates with CDH. We suggest that improvement of oxygenation during the first 24 h, along with other relevant clinical signs, should be used when making decisions regarding treatment options in these critically ill neonates.
authors.affiliation: Department of Pediatrics, University of Zagreb, School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia.
authors.forename: Ruža
authors.initials: R
authors.lastname: Grizelj
authors.affiliation: Department of Obstetrics and Gynecology, University Hospital Merkur, Zagreb, Croatia.
authors.forename: Katarina
authors.initials: K
authors.lastname: Bojanić
authors.affiliation: Department of Pediatrics, University of Zagreb, School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia.
authors.forename: Ena
authors.initials: E
authors.lastname: Pritišanac
authors.affiliation: Department of Pediatric Surgery, University of Zagreb, School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia.
authors.forename: Tomislav
authors.initials: T
authors.lastname: Luetić
authors.affiliation: Department of Pediatrics, University of Zagreb, School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia.
authors.forename: Jurica
authors.initials: J
authors.lastname: Vuković
authors.affiliation: Department of Anesthesiology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
authors.forename: Toby N
authors.initials: TN
authors.lastname: Weingarten
authors.affiliation: Division of Biomedical Statistics and Informatics, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
authors.forename: Darrell R
authors.initials: DR
authors.lastname: Schroeder
authors.affiliation: Department of Anesthesiology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA. sprung.juraj@mayo.edu.
authors.forename: Juraj
authors.initials: J
authors.lastname: Sprung
mesh_terms: D015415:Biomarkers / Q000097:blood; D001784:Blood Gas Analysis; D002196:Capillaries / Q000378:metabolism*; D002245:Carbon Dioxide / Q000097:blood*; D017523:Croatia / Q000453:epidemiology; D005260:Female; D065630:Hernias, Diaphragmatic, Congenital / Q000097:blood / Q000175:diagnosis / Q000401:mortality*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D010100:Oxygen / Q000097:blood*; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate
chemical_list: D015415:Biomarkers; D002245:Carbon Dioxide; D010100:Oxygen
keywords: Capillary blood gases; Clinical prediction; Congenital diaphragmatic hernia; Outborn; Outcome; Risk assessment; Survival