Tidal volumes at birth as predictor for adverse outcome in congenital diaphragmatic hernia

2019 ◽  
Vol 105 (3) ◽  
pp. 248-252 ◽  
Author(s):  
Arenda Mank ◽  
Cristina Carrasco Carrasco ◽  
Marta Thio ◽  
Jordi Clotet ◽  
Steffen C Pauws ◽  
...  
Keyword(s):  
Congenital Diaphragmatic Hernia ◽  
Diaphragmatic Hernia ◽  
Respiratory Function ◽  
Neonatal Intensive Care ◽  
Roc Analysis ◽  
Predictive Accuracy ◽  
Adverse Outcome ◽  
Independent Predictor ◽  
Area Under The Curve ◽  
Operating Characteristics

ObjectiveTo assess the predictive value of tidal volume (Vt) of spontaneous breaths at birth in infants with congenital diaphragmatic hernia (CDH).DesignProspective study.SettingTertiary neonatal intensive care unit.PatientsThirty infants with antenatally diagnosed CDH born at Hospital Sant Joan de Déu in Barcelona from September 2013 to September 2015.InterventionsSpontaneous breaths and inflations given in the first 10 min after intubation at birth were recorded using respiratory function monitor. Only expired Vt of uninterrupted spontaneous breaths was included for analysis. Receiver operating characteristics (ROC) analysis was performed and the area under the curve (AUC) was estimated to assess the predictive accuracy of Vt.Main outcome measuresMortality before hospital discharge and chronic lung disease (CLD) at day 28 of life.ResultsThere were 1.233 uninterrupted spontaneous breaths measured, and the overall mean Vt was 2.8±2.1 mL/kg. A lower Vt was found in infants who died (n=14) compared with survivors (n=16) (1.7±1.6 vs 3.7±2.1 mL/kg; p=0.008). Vt was lower in infants who died during admission or had CLD (n=20) compared with survivors without CLD (n=10) (2.0±1.7 vs 4.3±2.2 mL/kg; p=0.004). ROC analysis showed that Vt ≤2.2 mL/kg predicted mortality with 79% sensitivity and 81% specificity (AUC=0.77, p=0.013). Vt ≤3.4 mL/kg was a good predictor of death or CLD (AUC=0.80, p=0.008) with 85% sensitivity and 70% specificity.ConclusionVt of spontaneous breaths measured immediately after birth is associated with mortality and CLD. Vt seems to be a reliable predictor but is not an independent predictor after adjustment for observed/expected lung to head ratio and liver position.

scholarly journals Drain output volume after pancreaticoduodenectomy is a useful warning sign for postoperative complications

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Taro Fukui ◽  
Hiroshi Noda ◽  
Fumiaki Watanabe ◽  
Takaharu Kato ◽  
Yuhei Endo ◽  
...  
Keyword(s):  
Predictive Value ◽  
Roc Analysis ◽  
Independent Predictor ◽  
Area Under The Curve ◽  
Warning Sign ◽  
Operating Characteristics ◽  
Protein Loss ◽  
Chyle Leak ◽  
Major Complications ◽  
Output Volume

Abstract Introduction The drain output volume (DOV) after pancreaticoduodenectomy (PD) is an easily assessable indicator in clinical settings. We explored the utility of the DOV as a possible warning sign of complications after PD. Methods A total of 404 patients undergoing PD were considered for inclusion. The predictability of the DOV for overall morbidity, major complications, intraabdominal infection (IAI), clinically relevant (CR) postoperative pancreatic fistula (POPF), CR delayed gastric emptying (DGE), CR chyle leak (CL), and CR post-pancreatectomy hemorrhaging (PPH) was evaluated. Results One hundred (24.8%) patients developed major complications, and 131 (32.4%) developed IAI. Regarding CR post-pancreatectomy complications, 75 (18.6%) patients developed CR-POPF, 23 (5.7%) developed CR-DGE, 20 (5.0%) developed CR-CL, and 28 (6.9%) developed CR-PPH. The median DOV on postoperative day (POD) 1 and POD 3 was 266 and 234.5 ml, respectively. A low DOV on POD 1 was an independent predictor of CR-POPF, and a high DOV on POD 3 was an independent predictor of CR-CL. A receiver operating characteristics (ROC) analysis revealed that the DOV on POD 1 had a negative predictive value (area under the curve [AUC] 0.655, sensitivity 65.0%, specificity 65.3%, 95% confidence interval [CI]: 0.587–0.724), with a calculated optimal cut-off value of 227 ml. An ROC analysis also revealed that the DOV on POD 3 had a positive predictive value (AUC 0.753, sensitivity 70.1%, specificity 75.0%, 95% CI: 0.651–0.856), with a calculated optimal cut-off value of 332 ml. Conclusion A low DOV on POD 1 might be a postoperative warning sign for CR-POPF, similar to high drain amylase (DA) on POD 1, high DA on POD 3, and high CRP on POD 3. When the DOV on POD 1 after PD was low, surgeons should evaluate the reasons of a low DOV. A high DOV on POD 3 was a postoperative warning sign CR-CL, and might require an appropriate management of protein loss.

Hérnia Diafragmática Congênita: Relato de Caso/ Congenital Diaphragmatic Hernia: Case Report

1970 ◽  
Vol 3 (1) ◽  
pp. 27-34
Author(s):  
Lucas Tavares Dos Santos ◽  
Tânia Massini Evangelista
Keyword(s):  
Case Report ◽  
Congenital Diaphragmatic Hernia ◽  
Diaphragmatic Hernia ◽  
Neonatal Intensive Care ◽  
Esophageal Hiatus ◽  
Bochdalek Hernia ◽  
Severe Respiratory Distress ◽  
X Ray ◽  
Venous Catheterization ◽  
Terapia Intensiva

Introdução: A hérnia diafragmática congênita é a falha do fechamento embrionário do músculo diafragmático, resultando em um defeito de continuidade. Esta patologia pode ocorrer pela passagem de estruturas do abdome através de um defeito no diafragma, ou haver herniação parcial do estômago através do hiato esofágico, paralisia frênica com deslocamento do conteúdo abdominal para cima, mas sem herniação, e, eventração do diafragma. Casuística: Foi relatado um caso de hérnia diafragmática congênita, hérnia de Bochdalek, em um recém – nascido do sexo feminino, que nos ultra-sonografias da gestante apresentavam sem alterações. O diagnóstico da patologia foi feito apenas após a realização de raios-X de tórax e abdome para confirmar a posição do cateterismo umbilical venoso. Discussão/Conclusão: A apresentação clínica da hérnia de diafragmática congênita inclui desconforto respiratório moderado a grave com repercussão sistêmica. O diagnóstico, em cerca de 80% dos casos, é feito por ultrassom pré-natal. O tratamento proposto foi intubação endotraqueal com ventilação mecânica e programação para correção cirúrgica da hérnia. Após correção cirúrgica da patologia, a paciente permaneceu na unidade de terapia intensiva neonatal por 21 dias para acompanhamento de pós – operatório e intercorrências na evolução. Palavras-chave: hérnia diafragmática congênita, recém-nascido, hérnia de BochdalekABSTRACTIntroduction: Congenital diaphragmatic hernia is the failure of embryonic closure of the diaphragm, resulting in a lack of continuity. This condition can occur by passing structures of the abdomen through a defect in the diaphragm, or be part herniation of the stomach through the esophageal hiatus, phrenic paralysis with displacement of abdominal contents up but no herniation, and eventration of the diaphragm. Case Report: We report a case congenital diaphragmatic hernia, such as Bochdalek hernia, in a new - born female that in ultrasounds of pregnant women showed without change. The diagnosis of the disease was made only after conducting X-ray of the chest and abdomen to confirm the position of umbilical venous catheterization. Discussion/Conclusion: Clinical presentation of congenital diaphragmatic hernia includes moderate to severe respiratory distress with systemic repercussions. The diagnosis in about 80% of the cases is done by ultrasound prenatally. The proposed treatment was endotracheal intubation with mechanical ventilation and programming for surgical correction of the hernia. After surgical pathology, the patient remained in neonatal intensive care unit for 21 days to monitor post - operative complications and evolution.  Keywords: congenital diaphragmatic hernia, newborn, Bochdalek hernia 

Mothers of Infants With Congenital Diaphragmatic Hernia Describe “Breastfeeding” in the Neonatal Intensive Care Unit: “As Long as It’s My Milk, I’m Happy”

2017 ◽  
Vol 33 (3) ◽  
pp. 524-532 ◽  
Author(s):  
Elizabeth B. Froh ◽  
Janet A. Deatrick ◽  
Martha A. Q. Curley ◽  
Diane L. Spatz
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Neonatal Intensive Care Unit ◽  
Congenital Diaphragmatic Hernia ◽  
Diaphragmatic Hernia ◽  
Neonatal Intensive Care ◽  
Safety Net ◽  
Prospective Longitudinal

Background: Very little is known about the breastfeeding experience of mothers of infants born with congenital anomalies and cared for in the neonatal intensive care unit (NICU). Often, studies related to breastfeeding and lactation in the NICU setting are focused on the mothers of late preterm, preterm, low-birth-weight, and very-low-birth-weight infants. Congenital diaphragmatic hernia (CDH) is an anatomic malformation of the diaphragm and affects 1 in every 2,000 to 4,000 live births. Currently, there are no studies examining the health outcomes of infants with CDH and the effect of human milk. Research aim: This study aimed to describe the breastfeeding experience of mothers of infants with CDH cared for in the NICU. Methods: A prospective, longitudinal qualitative descriptive design was used. Phased interviews were conducted with a purposive sample of 11 CDH infant–mother dyads from a level 3 NICU in a children’s hospital. Results: Six themes emerged from the data: (a) hopeful for breastfeeding, (b) latching on . . . to the pump, (c) we’ve already worked so hard, (d) getting the hang of it—it’s getting easier, (e) a good safety net, and (f) finding a way that works for us. Conclusion: For this population of CDH infant–mother dyads, the term breastfeeding is not exclusive to direct feeding at the breast and the mothers emphasized the significance of providing their own mother’s milk through a combination of feeding mechanisms to their infants with CDH.

Unilateral renal agenesis in a neonate with congenital diaphragmatic hernia

Open Medicine ◽  
2013 ◽  
Vol 8 (3) ◽  
pp. 358-361
Author(s):  
Kyoung Han ◽  
Kwang Kim ◽  
Jee Chang ◽  
Young Kim
Keyword(s):  
Congenital Diaphragmatic Hernia ◽  
Diaphragmatic Hernia ◽  
Neonatal Intensive Care ◽  
Renal Agenesis ◽  
Left Kidney ◽  
Maternity Hospital ◽  
Unilateral Renal Agenesis ◽  
Spontaneous Vaginal Delivery ◽  
Left Pleural Cavity ◽  
Dimercaptosuccinic Acid Scintigraphy

AbstractCongenital diaphragmatic hernia (CDH) is a rare and severe disorder with a high mortality rate among infants. Unilateral renal agenesis (URA) is a relatively common congenital urinary malformation. Here, we present the case of a newborn infant with left CDH associated with ipsilateral renal agenesis. The male patient was born weighing 3.850 g through normal spontaneous vaginal delivery at 38 weeks and 6 days of gestational age at a maternity hospital. He was transferred to our neonatal intensive care unit due to respiratory distress with tachypnea, grunting and cyanosis after birth. A chest radiography indicated parts of the bowel in the thoracic cavity, consistent with CDH. Renal ultrasonography indicated no kidney structure on the left side and a 5.6 cm right kidney with normal echogenicity. Repair of the diaphragmatic hernia was performed three days after birth. Most of the colon, small bowel, stomach and spleen were located in the left pleural cavity, but the left kidney was not seen. Subsequent dimercaptosuccinic acid scintigraphy indicated non-visualized functional cortical uptake in the left kidney on day 13 after birth. Thus, we report the successful treatment of a patient with CDH accompanied by URA.

Sensitivity and specificity of Sirius indices in diagnosis of keratoconus and suspect keratoconus

2021 ◽  
pp. 112067212110601
Author(s):  
Abdelrahman Salman ◽  
Taym Darwish ◽  
Ali Ali ◽  
Marwan Ghabra ◽  
Rafea Shaaban
Keyword(s):  
Sensitivity And Specificity ◽  
Predictive Accuracy ◽  
Corneal Thickness ◽  
Case Series ◽  
Area Under The Curve ◽  
Receiver Operating Characteristics ◽  
Operating Characteristics ◽  
Symmetry Index ◽  
Case Series Study ◽  
Receiver Operating

Aim To estimate the sensitivity and specificity of topographic and tomographic corneal parameters as determined by Sirius (CSO, Florence, Italy) in discriminating keratoconus (KC) and suspect keratoconus from normal cornea. Method In this retrospective case-series study, keratoconus screening indices were measured using Sirius tomographer. Receiver operating characteristics (ROC) curves were used to determine the test's overall predictive accuracy (area under the curve) and to identify optimal cut-off points to maximize sensitivity and specificity in differentiating keratoconus and suspect keratoconus from normal corneas. Results Receiver operating characteristics (ROC) curve analyses showed high predictive accuracy for Symmetry Index back (SIb), Keratoconus Vertex front (KVf), Symmetry Index front (SIf), Keratoconus Vertex back (KVb), Apex Keratometry (Curve-Apex) and Minimum corneal Thickness (ThkMin) to distinguish keratoconus from normal (area under the curve > 0.9, all). Symmetry Index back was identified as the best diagnostic parameter for detecting suspect keratoconus with AUC of 0.86. Highest specificity to detect keratoconus and suspect keratoconus was seen for SIb, 99.87% and 84.66%, respectively. These values were associated with optimal cut-off points of 0.46 D for keratoconus and 0.12 D for suspect keratoconus. Conclusion Sirius parameters evaluated in the study were effective to differentiate keratoconus from normal corneas. However, Symmetry Index back was the index with the highest ability to detect suspect keratoconus.

scholarly journals Seasonality, Epidemiology and Outcome of Congenital Diaphragmatic Hernia in South West of Iran

2017 ◽  
Vol 6 (2) ◽  
pp. 28 ◽  
Author(s):  
Masoud Dehdashtian ◽  
Shiva Bashirnejad ◽  
Arash Malekian ◽  
Mohammad Reza Aramesh ◽  
Mohammad Hasan Aletayeb
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Seasonal Variation ◽  
Mortality Rate ◽  
Congenital Diaphragmatic Hernia ◽  
Diaphragmatic Hernia ◽  
Neonatal Intensive Care ◽  
South West ◽  
Very High

Introduction: The pathogenesis of congenital diaphragmatic hernia (CDH) is not clear. Risk factors including environmental factors have been implicated in the pathogenesis of few congenital anomalies. We aimed to assess the effect of season on the incidence of CDH and mortality rate in the southwest of Iran.Material and Methods: In this retrospective study, the records of 60 patients with CDH who were admitted at Neonatal Intensive Care Unit (NICU) of Imam Khomeini Hospital of Ahvaz, Iran were evaluated.Results: Assuming that all the neonates born with CDH in the region reach this hospital, overall CDH prevalence rate was 1.09 per 10 000 total births. Conceptions in spring and summer in this region had statistically significantly higher incidence of CDH. Survival rate in the series was 41.6%.Conclusion: Seasonal variation has impact on the incidence of CDH. Mortality rate in neonates with CDH is still very high.

Using machine learning algorithms to predict response and toxicity to immune checkpoint inhibitors (ICIs) in melanoma patients.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 2581-2581 ◽  
Author(s):  
Paul Johannet ◽  
Nicolas Coudray ◽  
George Jour ◽  
Douglas MacArthur Donnelly ◽  
Shirin Bajaj ◽  
...  
Keyword(s):  
Machine Learning ◽  
Immune Checkpoint ◽  
Immune Checkpoint Inhibitors ◽  
Predictive Accuracy ◽  
Checkpoint Inhibitors ◽  
Learning Algorithms ◽  
Area Under The Curve ◽  
Machine Learning Algorithms ◽  
Operating Characteristics ◽  
Melanoma Patients

2581 Background: There is growing interest in optimizing patient selection for treatment with immune checkpoint inhibitors (ICIs). We postulate that phenotypic features present in metastatic melanoma tissue reflect the biology of tumor cells, immune cells, and stromal tissue, and hence can provide predictive information about tumor behavior. Here, we test the hypothesis that machine learning algorithms can be trained to predict the likelihood of response and/or toxicity to ICIs. Methods: We examined 124 stage III/IV melanoma patients who received anti-CTLA-4 (n = 81), anti-PD-1 (n = 25), or combination (n = 18) therapy as first line. The tissue analyzed was resected before treatment with ICIs. In total, 340 H&E slides were digitized and annotated for three regions of interest: tumor, lymphocytes, and stroma. The slides were then partitioned into training (n = 285), validation (n = 26), and test (n = 29) sets. Slides were tiled (299x299 pixels) at 20X magnification. We trained a deep convolutional neural network (DCNN) to automatically segment the images into each of the three regions and then deconstruct images into their component features to detect non-obvious patterns with objectivity and reproducibility. We then trained the DCNN for two classifications: 1) complete/partial response versus progression of disease (POD), and 2) severe versus no immune-related adverse events (irAEs). Predictive accuracy was estimated by area under the curve (AUC) of receiver operating characteristics (ROC). Results: The DCNN identified tumor within LN with AUC 0.987 and within ST with AUC 0.943. Prediction of POD based on ST-only always performed better than prediction based on LN-only (AUC 0.84 compared to 0.61, respectively). The DCNN had an average AUC 0.69 when analyzing only tumor regions from both LN and ST data sets and AUC 0.68 when analyzing tumor and lymphocyte regions. Severe irAEs were predicted with limited accuracy (AUC 0.53). Conclusions: Our results support the potential application of machine learning on pre-treatment histologic slides to predict response to ICIs. It also revealed their limited value in predicting toxicity. We are currently investigating whether the predictive capability of the algorithm can be further improved by incorporating additional immunologic biomarkers.

scholarly journals A Case of Fatal Pulmonary Hypoplasia with Congenital Diaphragmatic Hernia, Thoracic Myelomeningocele, and Thoracic Dysplasia

2017 ◽  
Vol 07 (04) ◽  
pp. e234-e237
Author(s):  
Ai Ito ◽  
Hideshi Fujinaga ◽  
Sachiko Matsui ◽  
Kumiko Tago ◽  
Yuka Iwasaki ◽  
...  
Keyword(s):  
Congenital Diaphragmatic Hernia ◽  
Diaphragmatic Hernia ◽  
Neonatal Intensive Care ◽  
Pulmonary Hypoplasia ◽  
Left Kidney ◽  
Fatal Case ◽  
Male Infant ◽  
Skeletal Deformity ◽  
Severe Scoliosis ◽  
Severe Hydrocephalus

Background Congenital diaphragmatic hernia (CDH) is fatal in severe cases of pulmonary hypoplasia. We experienced a fatal case of pulmonary hypoplasia due to CDH, thoracic myelomeningocele (MMC), and thoracic dysplasia. This constellation of anomalies has not been previously reported. Case Report A male infant with a prenatal diagnosis of thoracic MMC with severe hydrocephalus and scoliosis was born at 36 weeks of gestation. CDH was found after birth and the patient died of respiratory failure due to pulmonary hypoplasia and persistent pulmonary hypertension of the newborn at 30 hours of age despite neonatal intensive care. An autopsy revealed a left CDH without herniation of the liver or stomach into the thoracic cavity, severe hydrocephalus, Chiari malformation type II, MMC with spina bifida from Th4 to Th12, hemivertebrae, fused ribs, deformities of the thoracic cage and legs, short trunk, and agenesis of the left kidney. Conclusion We speculate that two factors may be associated with the severe pulmonary hypoplasia: decreased thoracic space due to the herniation of visceral organs caused by CDH and thoracic dysplasia due to skeletal deformity and severe scoliosis.

scholarly journals Fukuda Stepping Test: Sensitivity and Specificity

2009 ◽  
Vol 20 (05) ◽  
pp. 311-314 ◽  
Author(s):  
Julie A. Honaker ◽  
Thomas E. Boismier ◽  
Nathan P. Shepard ◽  
Neil T. Shepard
Keyword(s):  
Sensitivity And Specificity ◽  
Roc Analysis ◽  
Screening Tool ◽  
Area Under The Curve ◽  
Future Research ◽  
Operating Characteristics ◽  
Caloric Irrigation ◽  
Test Sensitivity ◽  
Unilateral Weakness ◽  
Vestibular Asymmetry

Background: A vestibulospinal test known as the Fukuda stepping test (FST) has been suggested to be a measure of asymmetrical labyrinthine function. However, an extensive review of the performance of this test to identify a peripheral vestibular lesion has not been reported. Purpose: The purpose of this study was to evaluate the sensitivity and specificity of the standard FST and a head shaking variation for identification of a peripheral vestibular system lesion. Research Design: In this retrospective review, we compared performance on the FST with and without a head shaking component to electronystagmography (ENG) caloric irrigation unilateral weakness results. Study Sample: We studied these factors in 736 chronic dizzy patients. Results: Receiving operating characteristics (ROC) analysis and area under the curve (AUC) indicated no significant benefit to performance from the head shaking variation compared to the standard FST in identifying labyrinthine weakness as classified by caloric unilateral weakness results. Conclusions: These findings suggest that the FST with and without head shake component is not a reliable screening tool for peripheral vestibular asymmetry in chronic dizzy patients; however, future research may hold promise for the FST as a tool for patients with acute unilateral disorders.

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