The Chest Radiographic Thoracic Area Can Serve as a Prediction Marker for Morbidity and Mortality in Infants With Congenital Diaphragmatic Hernia

Objective: Valid postnatal prediction parameters for neonates with congenital diaphragmatic hernia (CDH) are lacking, but recently, the chest radiographic thoracic area (CRTA) was proposed to predict survival with high sensitivity. Here, we evaluated whether the CRTA correlated with morbidity and mortality in neonates with CDH and was able to predict these with higher sensitivity and specificity than prenatal observed-to-expected (O/E) lung-to-head ratio (LHR).Methods: In this retrospective cohort study, all neonates with CDH admitted to our institution between 2013 and 2019 were included. The CRTA was measured using the software Horos (V. 3.3.5) and compared with O/E LHR diagnosed by fetal ultrasonography in relation to outcome parameters including survival, extracorporeal membrane oxygenation (ECMO) support, and chronic lung disease (CLD).Results: In this study 255 neonates were included with a survival to discharge of 84%, ECMO support in 46%, and 56% developing a CLD. Multiple regression analysis demonstrated that the CRTA correlates significantly with survival (p = 0.001), ECMO support (p < 0.0001), and development of CLD (p = 0.0193). The CRTA displayed a higher prognostic validity for survival [area under the curve (AUC) = 0.822], ECMO support (AUC = 0.802), and developing a CLD (AUC = 0.855) compared with the O/E LHR.Conclusions: Our data suggest that the postnatal CRTA might be a better prognostic parameter for morbidity and mortality than the prenatal O/E LHR.

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Prenatal Prognostic Factors for Isolated Right Congenital Diaphragmatic Hernia: A Single Center’s Experience

10.21203/rs.3.rs-763037/v1 ◽

2021 ◽

Author(s):

Jiyoon Jeong ◽

Byong Sop Lee ◽

Teahyen Cha ◽

Euiseok Jung ◽

Ellen Ai-Rhan Kim ◽

...

Keyword(s):

Congenital Diaphragmatic Hernia ◽

Diaphragmatic Hernia ◽

Newborn Infants ◽

Area Under The Curve ◽

Fetal Lung ◽

Ecmo Support ◽

Prognostic Indicators ◽

Short Term ◽

Support Area ◽

Postnatal Outcome

Abstract Background: Right-sided congenital diaphragmatic hernia (RCDH) is relatively rare. Clinical data of RCDH, especially with respect to antenatal prediction of neonatal outcome, are lacking. This study aimed to report the treatment outcome of newborn infants with RCDH and to identify prenatal prognostic indicators. Methods: We retrospectively reviewed the medical records of newborn infants with isolated RCDH who were born at a gestational age of ≥35 weeks. We analyzed and compared the clinical and prenatal characteristics including the fetal lung volume, which was measured as the observed-to-expected lung area-to-head circumference ratio (O/E LHR), between the survivors and non-survivors. Results: A total of 24 (70.6%) of 34 patients with isolated RCDH survived to discharge. The O/E LHR was significantly greater in survivors (67.0 ± 19.9) than in non-survivors (42.4 ± 25.0) (P < .05). In multivariate analysis, the O/E LHR was found to be a good predictor of mortality or requirement for extracorporeal membrane oxygenation (ECMO) support (area under the curve [AUC], 0.870; P < .01) and mortality (AUC, 0.789; P < .05). The best O/E LHR cut-off value for predicting mortality and mortality or requirement for ECMO support in isolated RCDH was 47. Conclusions: The survival rate of patients with isolated RCDH was comparable to that of patients with left-sided CDH. The O/E LHR of the contralateral lung was a reliable predictor of short-term postnatal outcome in RCDH.

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Oxygen Saturation Index in Neonates with a Congenital Diaphragmatic Hernia: A Retrospective Cohort Study

Neonatology ◽

10.1159/000520883 ◽

2021 ◽

pp. 1-8

Author(s):

Emily J.J. Horn-Oudshoorn ◽

Marijn J. Vermeulen ◽

Kelly J. Crossley ◽

Suzan C.M. Cochius-den Otter ◽

J. Marco Schnater ◽

...

Keyword(s):

Cohort Study ◽

Oxygen Saturation ◽

Congenital Diaphragmatic Hernia ◽

Diaphragmatic Hernia ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Saturation Index ◽

Neonatal Outcomes ◽

Predictive Values ◽

Adverse Neonatal Outcomes

Introduction: The oxygenation index (OI) is a marker for respiratory disease severity and adverse neonatal outcomes. The oxygen saturation index (OSI) is an alternative that allows for continuous noninvasive monitoring, but evidence for clinical use in critically ill neonates is scarce. The aim of this study was to evaluate the OSI as compared to the OI in term neonates with a congenital diaphragmatic hernia (CDH). Methods: A single-center retrospective cohort study was conducted including all live-born infants with an isolated CDH between June 2017 and December 2020. Paired values of the OI and OSI in the first 24 h after birth were collected. The relation between OI and OSI measurements was assessed, taking into account arterial pH, body temperature, and preductal versus postductal location of oxygen saturation measurement or arterial blood sampling. The predictive values for pulmonary hypertension, need for extracorporeal membrane oxygenation therapy, and survival at discharge were evaluated. Results: Of 33 subjects included, 398 paired values of the OI (median 5.8 [3.3–17.2]) and OSI (median 7.3 [3.6–14.4]) were collected. The OI and OSI correlated strongly (r = 0.77, p < 0.001). The OSI values corresponding to the clinically relevant OI values (10, 15, 20, and 40) were 8.9, 10.9, 12.9, and 20.9, respectively. The predictive values of the OI and OSI were comparable for all adverse neonatal outcomes. No difference was found in the area under the receiver operating characteristic curves for the OI and the OSI for adverse neonatal outcomes. Conclusions: The OSI could replace the OI in clinical practice in infants with a CDH.

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A comparison of the 33-item Hypomania Checklist with the 33-item Hypomania Checklist-external assessment for the detection of bipolar disorder in adolescents

International Journal of Bipolar Disorders ◽

10.1186/s40345-021-00246-0 ◽

2021 ◽

Vol 9 (1) ◽

Author(s):

Xu Chen ◽

Wei Bai ◽

Na Zhao ◽

Sha Sha ◽

Teris Cheung ◽

...

Keyword(s):

Bipolar Disorder ◽

Predictive Value ◽

Area Under The Curve ◽

High Sensitivity ◽

Adverse Outcomes ◽

Clinical Settings ◽

External Assessment ◽

Appropriate Treatment ◽

Youden’S Index ◽

Higher Sensitivity

Abstract Background Adolescents with bipolar disorder (BD) are often misdiagnosed as having major depressive disorder (MDD), which delays appropriate treatment and leads to adverse outcomes. The aim of this study was to compare the performance of the 33-item Hypomania Checklist (HCL-33) with the 33-item Hypomania Checklist- external assessment (HCL-33-EA) in adolescents with BD or MDD. Methods 147 adolescents with BD and 113 adolescents with MDD were consecutively recruited. The HCL-33 and HCL-33-EA were completed by patients and their carers, respectively. The sensitivity, positive predictive value (PPV), specificity, negative predictive value (NPV), and area under the curve (AUC) were calculated and compared between the two instruments, using cut-off values based on the Youden’s index. Results The total scores of the HCL-33 and HCL-33-EA were positively and significantly correlated (rs = 0.309, P < 0.001). Compared to the HCL-33, the HCL-33-EA had higher sensitivity and NPV (HCL-33: sensitivity = 0.58, NPV = 0.53; HCL-33-EA: sensitivity = 0.81, NPV = 0.60), while the HCL-33 had higher specificity and PPV (HCL-33: specificity = 0.61, PPV = 0.66; HCL-33-EA: specificity = 0.37, PPV = 0.63). Conclusion Both the HCL-33 and HCL-33-EA seem to be useful for screening depressed adolescents for BD. The HCL-33-EA would be more appropriate for distinguishing BD from MDD in adolescents due to its high sensitivity in Chinese clinical settings.

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CONGENITAL DIAPHRAGMATIC HERNIA: THE IMPACT OF THIS CONGENITAL ANOMALY ON PAEDIATRIC MORBIDITY AND MORTALITY

Fetal and Maternal Medicine Review ◽

10.1017/s0965539503001050 ◽

2003 ◽

Vol 14 (2) ◽

pp. 145-154

Author(s):

JANET R ASHWORTH ◽

ANTHONY D LANDER

Keyword(s):

Congenital Anomaly ◽

Congenital Diaphragmatic Hernia ◽

Diaphragmatic Hernia ◽

Healthcare Professionals ◽

Antenatal Diagnosis ◽

Morbidity And Mortality ◽

Fetal Anomaly ◽

The Impact ◽

Clear Information

When an antenatal diagnosis of a fetal anomaly is made, the parents need accurate and clear information regarding prognosis and possible outcomes, to help them make decisions. The healthcare professionals, who are involved in their care and counselling, also need this information.

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Pulmonary support on Day 30 as a predictor of morbidity and mortality in congenital diaphragmatic hernia

Journal of Pediatric Surgery ◽

10.1016/j.jpedsurg.2013.03.012 ◽

2013 ◽

Vol 48 (6) ◽

pp. 1183-1189 ◽

Cited By ~ 16

Author(s):

Ryan P. Cauley ◽

Alexander Stoffan ◽

Kristina Potanos ◽

Nora Fullington ◽

Dionne A. Graham ◽

...

Keyword(s):

Congenital Diaphragmatic Hernia ◽

Diaphragmatic Hernia ◽

Morbidity And Mortality

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Outcome of Congenital Diaphragmatic Hernia: A Single Center Experience

Journal of Neonatal Surgery ◽

10.47338/jns.v8.354 ◽

2020 ◽

Vol 8 (4) ◽

pp. 29

Author(s):

Jayasree Chandramati ◽

Lakshmi S Nair ◽

Smriti M Menon ◽

Ashwin Prabhu ◽

Mohan Abraham ◽

...

Keyword(s):

Congenital Diaphragmatic Hernia ◽

Diaphragmatic Hernia ◽

Retrospective Cohort ◽

Prognostic Markers ◽

Fetal Lung ◽

Left Ventricular ◽

Management Guidelines ◽

Factors Associated ◽

Remarkable Improvement ◽

Single Center Experience

Background: Congenital diaphragmatic hernia (CDH) is a complex malformation with a challenging perioperative care. The outcome is still not very impressive in developing countries despite its remarkable improvement in developed countries.Methods: We analyzed outcomes, and factors associated with morbidity and mortality of 120 newborns with CDH, managed at our institution.Results: The overall survival was 73.4%. Chromosomal aberrations, pneumothorax within 24 hours, left ventricular hypoplasia, biventricular dysfunction, fetal lung to head ratio (LHR)Conclusion: This is the largest series of a retrospective cohort study of CDH reported in India. We have briefly reviewed the topic and the management guidelines along with prognostic markers derived from this study.

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