engleski

Malformacije udružene sa prirođenom dijafragmalnom kilom.

Background/Purpose: Congenital diaphragmatic hernia (CDH) is associated with high mortality. Survival is influenced by the extent of pulmonary hypoplasia and additional congenital defects. The purpose of this study was to assess the association of congenital anomalies and admission capillary carbon dioxide levels (PcCO2), as a measure of extent of pulmonary hypoplasia, on survival in neonates with CDH. Methods: This is a retrospective review of neonates with CDH admitted to a tertiary neonatal intensive care unit between 1990 and 2014. Logistic regressionwas used to assesswhether hospital survivalwas associated with admission PcCO2 or associated anomalies (isolated CDH, CDHwith cardiovascular anomalies, and CDHwith noncardiac anomalies). The probabilities of survival (POS) score, based on birth weight and 5-min Apgar as defined by the Congenital Diaphragmatic Hernia Study Group were included as a covariate. Results: Of 97 patients, 55 had additional malformations (cardiovascular n=12, noncardiac anomalies n=43). POSwas lower in CDHwith other anomalies compared to isolated CDH. Survival rate was 61.9%, 53.5% and 41.7% in isolated CDH, CDH with noncardiac anomalies and CDH with cardiovascular anomalies, respectively. After adjusting for POS score the likelihood of survival in CDH groups with additional anomalieswas similar to isolated CDH(OR 0.95, 95% CI 0.22–4.15, and 1.10, 0.39–3.08, for CDHwith and without cardiovascular anomalies, respectively). After adjusting for POS score, lower PcCO2 levels (OR=1.25 per 5 mmHg decrease, P=0.003) were associated with better survival. Conclusions: Neonates with CDH have a high prevalence of congenital malformations. However, after adjusting for POS score the presence of additional anomalieswas not associated with survival. The POS score and admission PcCO2 were important prognosticating factors for survival.

Capillary blood gas Capillary blood carbon dioxide level Congenital diaphragmatic hernia Congenital malformations Congenital heart disease Neonate Probability of survival Mortality Risk assessment

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