Predictors of the need for extracorporeal membrane oxygenation and survival in congenital diaphragmatic hernia: A center's 10-year experience

Anthony O. Odibo, Tasnim Najaf, Akshaya Vachharajani, Barbara Warner, Amit Mathur, Brad W. Warner

Research output: Contribution to journalArticlepeer-review

22 Scopus citations

Abstract

Objective: To determine the prenatal factors associated with the need for extracorporeal membrane oxygenation (ECMO) and neonatal survival in congenital diaphragmatic hernia (CDH). Study design: A retrospective cohort study of all cases of CDH seen in our center between 1998 and 2008. Prenatal ultrasound and neonatal records were reviewed. Both univariable and logistic regression analyses were performed to determine the significant factors associated with the use of ECMO and survival. Results: Among 107 cases of CDH seen during the study period, 62 were evaluated prenatally in our center and 49 had information on all variables evaluated. The overall rate of ECMO use was 27/107 (25%) and survival rate was 53/107 (49.5%). The lung area to head circumference ratio (LHR) and gestational age (GA) at delivery were the only significant factors associated with ECMO use, and the LHR and absence of liver herniation were significantly associated with survival. LHR values under 1.0 were associated with 57% need for ECMO and 100% neonatal death. Although, overall, the observed : expected LHR (O: E LHR) was not significantly associated with ECMO use or survival, levels below 65% were associated with 58% need for ECMO (p = 0.004) and 100% neonatal death (p = 0.002). Conclusion: The study confirms the LHR, GA at delivery and liver herniation as significant prenatal predictors of the need for ECMO or survival in cases with CDH. This information is helpful for counseling women with fetuses complicated by CDH.

Original languageEnglish
Pages (from-to)518-521
Number of pages4
JournalPrenatal Diagnosis
Volume30
Issue number6
DOIs
StatePublished - Jun 1 2010

Keywords

  • Diaphragmatic hernia
  • ECMO
  • Lung head ratio
  • Survival

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