Format

Send to

Choose Destination
Arch Dis Child Fetal Neonatal Ed. 2019 Jun 29. pii: fetalneonatal-2018-316504. doi: 10.1136/archdischild-2018-316504. [Epub ahead of print]

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

Author information

1
Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands.
2
Division of Neonatology, Department of Pediatrics, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain.
3
Newborn Research, Neonatal Services, The Royal Women's Hospital, Melbourne, Victoria, Australia.
4
Tilburg center for Cognition and Communication, Tilburg University, Tilburg, Noord-Brabant, The Netherlands.
5
Obstetrics, Erasmus MC, Rotterdam, The Netherlands.
6
The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria, Australia.

Abstract

OBJECTIVE:

To assess the predictive value of tidal volume (Vt) of spontaneous breaths at birth in infants with congenital diaphragmatic hernia (CDH).

DESIGN:

Prospective study.

SETTING:

Tertiary neonatal intensive care unit.

PATIENTS:

Thirty infants with antenatally diagnosed CDH born at Hospital Sant Joan de Déu in Barcelona from September 2013 to September 2015.

INTERVENTIONS:

Spontaneous 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 MEASURES:

Mortality before hospital discharge and chronic lung disease (CLD) at day 28 of life.

RESULTS:

There 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.

CONCLUSION:

Vt 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.

KEYWORDS:

congenital diaphragmatic hernia; neonatology; resuscitation; tidal volume

Conflict of interest statement

Competing interests: None declared.

Supplemental Content

Full text links

Icon for HighWire
Loading ...
Support Center