Utility of the oxygenation index in management of congenital diaphragmatic hernia: a report from a Thai University Surgical Centre
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In brief
In brief
This retrospective study of 55 CDH newborns demonstrates that oxygenation index measured during the first 72 hours of life strongly predicts mortality and need for advanced ventilation. Higher OI values correlated with preoperative death and guided surgical timing decisions in a Thai tertiary center.
- Higher oxygenation index (OI) in first 72 hours correlates with CDH mortality and need for high-frequency oscillatory ventilation
- OI on day 2 of life significantly predicts preoperative mortality risk in CDH newborns (42.1 vs 14.9 in survivors, p=0.04)
- Non-survivors had consistently elevated OI across days 1-3 compared to survivors (31.6 vs 10.5 on day 1, p<0.05)
- Serial OI monitoring can guide ventilatory management decisions and optimal timing for surgical repair in CDH patients
- Study of 55 CDH cases showed 40% mortality with OI trends strongly predictive of cardiorespiratory outcomes
Written by the GCMD Library team from the article.
Abstract
Background
Oxygenation index (OI) is associated with severity of newborn pulmonary hypertension (PH) in congenital diaphragmatic hernia (CDH). Higher OI may indicate worst degree(s) of PH.
Objectives
This study reports OI dynamic(s) over the first 72 h of life and its correlation with (1) perioperative morbidity and (2) CDH mortality.
Methods
Medical records of inborn CDH babies during 2002–2022 were examined. OI on Days (s) 1–3 and perioperative OI trends were recorded. Operation (primary vs patch repair) and survival rates (%) were studied.
Results
Fifty-five CDH newborns (54.5% male: 45.5% female)—mean birth GA 37.5 ± 2.7 wks. had a mean birth weight 2813 ± 684 g with prenatal diagnosis in 32.7% cases. 52/55 (94.5%) were intubated at birth and HFOV deployed in 29 (55.8%). Those requiring HFOV had higher OI on DOL1 (24.8 ± 17 vs 10.3 ± 11.5; p < 0.05), DOL 2 (26.3 ± 22.9 vs 6.7 ± 12.1; p < 0.05) and DOL 3 (21.9 ± 33.8 vs 5.5 ± 9.3; p = 0.04). Operation was undertaken in 36/55 (65.5%). Preoperative mortality group had significant higher OI on DOL 2 (42.1 ± 21.0 vs 14.9 ± 9.3; p = 0.04). CDH defects were—Type A N = 27 (75%), Type B N = 7 (19.4%) and Type C N = 2 (5.6%). Overall mortality was 40% (22/55). Statistically significant OI trends were recorded in non-survival vs. survival groups on DOL 1 (31.6 ± 16.8. vs 10.5 ± 9.0; p < 0.05, DOL 2 (38.1 ± 21.9 vs 6.3 ± 7.1; p < 0.05), and DOL 3 (38.8 ± 39.4; p = 0.012).
Conclusions
OI dynamics are highly predictive for accurate monitoring of CDH cardiorespiratory physiology and crucially may guide ventilatory management as well as timing of surgery.