先天性膈疝婴儿的生存预测及对吸入一氧化氮的反应。
Prediction of survival in infants with congenital diaphragmatic hernia and the response to inhaled nitric oxide.
机构信息
Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.
Neonatal Intensive Care Centre, King's College Hospital NHS Foundation Trust, London, UK.
出版信息
Eur J Pediatr. 2022 Oct;181(10):3683-3689. doi: 10.1007/s00431-022-04568-8. Epub 2022 Jul 28.
UNLABELLED
The use of inhaled nitric oxide (iNO) in treating pulmonary hypertension in infants with congenital diaphragmatic hernia (CDH) is controversial. Our aims were to identify factors associated with survival in CDH infants and whether this was influenced by the response to iNO. Results of CDH infants treated in a tertiary surgical and medical perinatal centre in a ten year period (2011-2021) were reviewed. Factors affecting survival were determined. To assess the response to iNO, blood gases prior to and 30 to 60 min after initiation of iNO were analysed and PaO/FiO ratios and oxygenation indices (OI) calculated. One hundred and five infants were admitted with CDH; 46 (43.8%) infants died. The CDH infants who died had a lower median observed to expected lung to head ratio (O/E LHR) (p < 0.001) and a higher median highest OI on day 1 (HOId1) (p < 0.001). HOId1 predicted survival after adjusting for gestational age, Apgar score at 5 min and O/E LHR (odds ratio 0.948 (95% confidence intervals 0.913-0.983)). Seventy-two infants (68.6%) received iNO; 28 survived to discharge. The median PaO (46.7 versus 58.8 mmHg, p < 0.001) and the median PaO/FiO ratio (49.4 versus 58.8, p = 0.003) improved post iNO initiation. The percentage change in the PaO/FiO ratio post iNO initiation was higher in infants who survived (69.4%) compared to infants who died (10.2%), p = 0.018.
CONCLUSION
The highest OI on day 1 predicted survival. iNO improved oxygenation in certain CDH infants and a positive response was more likely in those who survived.
WHAT IS KNOWN
• The use of iNO is controversial in infants with CDH with respect to whether it improves survival.
WHAT IS NEW
• We have examined predictors of survival in CDH infants including the response to iNO and demonstrated that the highest oxygenation index on day 1 predicted survival (AUCROC =0.908). • Certain infants with CDH responded to iNO and those with a greater response were more likely to survive.
目的
本研究旨在明确与先天性膈疝（CDH）患儿生存相关的因素，并确定这些因素是否受吸入一氧化氮（iNO）反应的影响。
方法
回顾 2011 年至 2021 年在一家三级外科和围产期医疗中心治疗的 CDH 患儿的临床资料。确定影响生存的因素。为评估 iNO 反应，分析 iNO 开始前 30 至 60 分钟和开始后即刻的血气值，并计算 PaO/FiO 比值和氧合指数（OI）。
结果
共纳入 105 例 CDH 患儿，其中 46 例（43.8%）死亡。死亡患儿的观察到的与预计的肺/头比（O/E LHR）更低（p<0.001），第 1 天的最高 OI 更高（HOId1）（p<0.001）。HOId1 在调整胎龄、5 分钟时的 Apgar 评分和 O/E LHR 后，对生存仍具有预测作用（比值比 0.948（95%置信区间 0.913-0.983））。72 例（68.6%）患儿接受 iNO 治疗，其中 28 例存活至出院。iNO 治疗后，PaO（46.7 对 58.8mmHg，p<0.001）和 PaO/FiO 比值（49.4 对 58.8，p=0.003）均升高。iNO 治疗后，PaO/FiO 比值升高百分比在存活患儿（69.4%）中高于死亡患儿（10.2%），p=0.018。
结论
第 1 天的最高 OI 预测生存。iNO 改善了某些 CDH 患儿的氧合，对存活患儿的效果更明显。
本研究的意义
我们研究了 CDH 患儿生存的预测因素，包括对 iNO 的反应，并证明第 1 天的最高氧合指数预测生存（AUCROC=0.908）。某些 CDH 患儿对 iNO 有反应，反应更大的患儿更有可能存活。
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