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Prediction of Mortality in Newborn Infants With Severe Congenital Diaphragmatic Hernia Using the Chest Radiographic Thoracic Area*

Dassios, Theodore, PhD1,2; Ali, Kamal, MD1; Makin, Erica, MSc3; Bhat, Ravindra, MD1; Krokidis, Miltiadis, PhD4; Greenough, Anne, MD2,5,6

Pediatric Critical Care Medicine: June 2019 - Volume 20 - Issue 6 - p 534–539
doi: 10.1097/PCC.0000000000001912
Neonatal Intensive Care
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Objectives: To evaluate whether the preoperative chest radiographic thoracic area in newborn infants with congenital diaphragmatic hernia was related to the length of mechanical ventilation and the total length of stay and whether chest radiographic thoracic area predicted survival to discharge from neonatal care.

Design: Retrospective observational cohort study.

Setting: Tertiary neonatal unit at King’s College Hospital National Health Service Foundation Trust, London, United Kingdom.

Patients: Newborn infants admitted with congenital diaphragmatic hernia at King’s College Hospital in a 10-year period (2007–2017).

Interventions: The chest radiographic thoracic area was assessed by free hand tracing of the perimeter of the thoracic area as outlined by the diaphragm and the rib cage and excluded the mediastinal structures and abdominal contents in the thorax and calculated using the Sectra PACS software (Sectra AB, Linköping, Sweden).

Measurements and Main Results: Eighty-four infants with congenital diaphragmatic hernia (70 left-sided) were included with a median (interquartile range) gestation of 36 weeks (34–39 wk). Fifty-four (64%) survived to discharge from neonatal care. In the infants who survived the chest radiographic thoracic area was not related to the length of mechanical ventilation (r = 0.136; p = 0.328) or the total duration of stay (r = 0.095; p = 0.495). The median (interquartile range) chest radiographic thoracic area was higher in infants who survived (1,780 mm2 [1,446–2,148 mm2]) compared with in the deceased infants (1,000 mm2 [663–1,449 mm2]) after correcting for confounders (adjusted p = 0.01). Using receiver operator characteristics analysis, the chest radiographic thoracic area predicted survival to discharge from neonatal care with an area under the curve of 0.826. A chest radiographic thoracic area higher than 1,299 mm2 predicted survival to discharge with 85% sensitivity and 73% specificity.

Conclusions: The chest radiograph in infants with severe congenital diaphragmatic hernia can predict survival from neonatal care with high sensitivity and moderate specificity.

1Neonatal Intensive Care Centre, King’s College Hospital National Health Service Foundation Trust, London, United Kingdom.

2Women and Children’s Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom.

3Department of Paediatric Surgery, King’s College Hospital National Health Service Foundation Trust, London, United Kingdom.

4Department of Radiology, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge, United Kingdom.

5MRC-Asthma UK Centre in Allergic Mechanisms of Asthma, King’s College London, London, United Kingdom.

6National Institute for Health Research Biomedical Research Centre based at Guy’s and St Thomas’ National Health Service Foundation Trust and King’s College London, London, United Kingdom.

*See also p. 575.

The views expressed are those of the author(s) and not necessarily those of the National Health Service, the National Institute for Health Research, or the Department of Health.

Supported, in part, by the National Institute for Health Research Biomedical Research Centre based at Guy’s and St Thomas’ National Health Service Trust and King’s College London.

Dr. Greenough has held grants from various manufacturers (Abbot Laboratories, MedImmune) and ventilator manufacturers (specialized laboratory equipment [SLE]); she has received honoraria for giving lectures and advising various manufacturers (Abbot Laboratories, MedImmune) and ventilator manufacturers (SLE); and she is currently receiving a nonconditional educational grant from SLE. The remaining authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: theodore.dassios@kcl.ac.uk

©2019The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies