Eur J Pediatr Surg 2010; 20(5): 290-293
DOI: 10.1055/s-0030-1253405
Original Article

© Georg Thieme Verlag KG Stuttgart · New York

Impact of Target Blood Gases on Outcome in Congenital Diaphragmatic Hernia (CDH)

M. E. Brindle1 , I. W. Y. Ma2 , E. D. Skarsgard3
  • 1University of Calgary, Pediatric General Surgery, Calgary, Canada
  • 2University of Calgary, Internal Medicine, Calgary, Canada
  • 3University of British Columbia, Pediatric General Surgery, Vancouver, Canada
Further Information

Publication History

received October 13, 2009

accepted after revision March 01, 2010

Publication Date:
27 May 2010 (online)

Abstract

Introduction: Neonatal intensive care unit (NICU) stabilization strategies which normalize physiology according to predetermined blood gas targets may contribute to observed improved survival rates of patients with CDH. The purpose of our study was to compare risk-adjusted outcomes of CDH patients managed with or without blood gas targets established at NICU admission.

Methods: Cases were collected from a national CDH network between May 2005 and November 2007. On NICU admission, the responsible neonatologist was asked to establish target ranges for pH, pCO2, pO2, and pre/post-ductal O2 saturation. The outcomes analyzed were mortality, need for ECMO, days of mechanical ventilation/supplemental oxygen, and length of stay.

Results: Of 147 CDH infants, 63 had admission blood gas targets. Severity of illness and gestational age in both groups were comparable (SNAP-II score). Infants with blood gas targets had a significantly lower mortality than those without (Hazard ratio 0.27, p=0.006).

Conclusions: Blood gas targets for the management of infants with CDH are associated with improved survival. Although the willingness to create and use stabilization targets to guide early NICU care may be a surrogate for other factors (experience, staffing, lack of interest), it is clearly associated with improved survival in CDH.

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Correspondence

Dr. Mary Elizabeth Brindle

University of Calgary

Pediatric General Surgery

Alberta Children's Hospital

T3B6A8 Calgary

Canada

Phone: +1 403 955 2848

Fax: +1 403 955 7634

Email: Mary.Brindle@albertahealthservices.ca