Document Type

Presentation

Publication Date

9-2-2009

Abstract

Background: Infants diagnosed with congenital diaphragmatic hernia (CDH) continue to have a high mortality despite medical advances such as inhaled nitric oxide (iNO), high frequency ventilation (HFV) and/or extracorporeal membrane oxygenation (ECMO). The mortality in some studies exceeds 80%. The modified McGoon index (MMI), a ratio of pulmonary artery size to aortic size has been reported to predict survivability in these infants: infants with a MMI ≤ 1.3 have an 85% mortality: (Pediatr 2000;105:1106). Objective: To evaluate the utility of MMI in predicting mortality in our population. Design/Methods: We performed a retrospective review of all infants with CDH admitted to the University of New Mexico NICU between January 2000 and November 2002. All available echocardiograms were reviewed by a single pediatric cardiologist blinded to the outcome of the infants, and the MMI was calculated (LPA + RPA/ Ao). The following information was also recorded from each infants record: gestational age, birth weight, Apgar scores, need for cardiopulmonary resuscitation in the delivery room, length of hospital stay, days of ventilation, use of high frequency ventilation, use of iNO, use of ECMO and survival to discharge. Results: Eighteen infants with CDH were admitted; echocardiograms were available for 15. MMI ranged from .06 to 2.37 in the 15 infants. Seven infants died and 8 survived to discharge. There was no significant difference in birth weight between groups (lived (L): 3151 ± 203; died (D): 2735 ± 186 grams, mean ± SE), gestational age (L: 38.3 ± .4; D: 38.3 ± 1.1), CPR in delivery room (L: 1/8; D: 3/7). Infants who died had lower 5-minute Apgar scores (L: 7.1± .5; D: 4.8 ± .7, p< 0.05). A greater number of infants who died received ECMO. There were no differences between groups in the number of infants on HFV or iNO. An MMI of ≤ 1.3 did not predict death in our patient population: mortality in patients with an MMI ≤ 1.3 was 46% (6 of 13 infants), while mortality in patients with MMI \u2265 1.3 was 50% (1 of 2 infants). Conclusion: MMI ≤ 1.3 did not predict mortality in our population.'

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