Bradley A. Kuch
Children’s Hospital of Pittsburgh of UPMC, USA
Title: Severity of Illness in the Early Pre-Surgical Management of Congenital Diaphragmatic Hernia
Biography
Biography: Bradley A. Kuch
Abstract
Congenital diaphragmatic hernia (CDH) continues to carry significant morbidity and mortality despite critical and surgical advances. It is estimated only 60% - 70% survive – usually in high-volume centers. Early pre-surgical management is often complicated by physiologic derangement secondary to varying degrees of lung hypoplasia, pulmonary hypertension, and a need for inter-facility transport. Infants who fail to achieve adequate oxygenation and/or perfusion with maximum medical support are regularly supported by extracorporeal membrane oxygenation (ECMO), further complicating the hospital course. These aforementioned challenges have led to a large body of evidence evaluating best practice outcomes; however questions remain regarding the best practice approaches to early stabilization and patient selection for ECMO. We have previously reported that pre-transport blood gases, fluid boluses, and ventilation parameters were associated with outcome; however only SNAPP-II score was found to be independently associated with ECMO (OR 1.13 [1.04-1.24]: p=0.007) and mortality (OR 1.11 [1.05-1.12]: p<0.0001) in out-born infants with CDH. In a larger dataset, we demonstrated that SNAPP-II (AUC: 0.77 vs. 0.67) performs better in predicted mortality compared to PaCO2 in the first 24 hours of life. Discussed will be the importance of severity of illness modeling in the CDH population, as it relates to stabilizing intervention and ECMO support. Current evidence concerning antenatal imaging of CDH and its relationship with severity of illness in the first 24 hours of life and outcome will be presented.