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Estimating Disease Severity of CDH in the first 5 Minutes of Life

In 1995, the CDH Study Group was established to collect and analyse multi-institutional data. The purpose of this study was to report a method of estimating risk, independent of treatment.

1,054 neonates with CDH (71 centers) were enrolled. Of these centers, the majority has the capability of using ECMO, and all have level III neonatal intensive care units. The overall survival rate was 64%, there were more boys affected than girls (621 v 378; P< .01) with no difference in survival between sexes.

To develop a treatment-independent risk assessment tool, logistic regression to variables that could be determined at or shortly after birth were applied.

The variables included in the model were gender, race, birth weight (BW), side of the hernia, estimated gestational age, prenatal diagnosis, Apgar score at 1 and 5 minutes of life, presence of immediate distress at birth, and requirement for cardiopulmonary resuscitation.

When examined by logistic regression analysis, only birth weight (P < .001), Apgar score at 5 minutes of life (P < .001), prenatal diagnosis (P < .05), and immediate distress (P < .01) were found to be statistically significant independent predictors of survival.

The individual factors were examined:
– Immediate distress and prenatal diagnosis added least to the predictive value and in addition
– Immediate distress is objectively assessed by Apgar score at 5 minutes and expert prenatal ultrasonography is not uniformly available.
Hence, both variables were excluded from the model.

5- minute Apgar and BW were found to be highly significant predictors of survival (P < .0001). This model was prospectively validated in a cohort of 732 patients. It was decided a priori to group patients in terciles of predicted mortality rate creating low ( 0 to 33%), moderate (34 to 66%), and high (67 to 100%) predicted mortality rate. This stratification scheme is designated to be used to estimate risks for populations, and to aid in stratification of prospective studies. It is not designed to be predictive of outcome in individual patients with CDH.

Congenital Diaphragmatic Hernia Study Group, Houston (J Ped Surg, Jan 2001)


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