PT  - JOURNAL ARTICLE
AU  - Arenda Mank
AU  - Cristina Carrasco Carrasco
AU  - Marta Thio
AU  - Jordi Clotet
AU  - Steffen C Pauws
AU  - Philip DeKoninck
AU  - Arjan B te Pas
TI  - Tidal volumes at birth as predictor for adverse outcome in congenital diaphragmatic hernia
AID  - 10.1136/archdischild-2018-316504
DP  - 2020 May 01
TA  - Archives of Disease in Childhood - Fetal and Neonatal Edition
PG  - 248--252
VI  - 105
IP  - 3
4099  - http://fn.bmj.com/content/105/3/248.short
4100  - http://fn.bmj.com/content/105/3/248.full
SO  - Arch Dis Child Fetal Neonatal Ed2020 May 01; 105
AB  - Objective To assess the predictive value of tidal volume (Vt) of spontaneous breaths at birth in infants with congenital diaphragmatic hernia (CDH).Design Prospective study.Setting Tertiary neonatal intensive care unit.Patients Thirty infants with antenatally diagnosed CDH born at Hospital Sant Joan de Déu in Barcelona from September 2013 to September 2015.Interventions Spontaneous breaths and inflations given in the first 10 min after intubation at birth were recorded using respiratory function monitor. Only expired Vt of uninterrupted spontaneous breaths was included for analysis. Receiver operating characteristics (ROC) analysis was performed and the area under the curve (AUC) was estimated to assess the predictive accuracy of Vt.Main outcome measures Mortality before hospital discharge and chronic lung disease (CLD) at day 28 of life.Results There were 1.233 uninterrupted spontaneous breaths measured, and the overall mean Vt was 2.8±2.1 mL/kg. A lower Vt was found in infants who died (n=14) compared with survivors (n=16) (1.7±1.6 vs 3.7±2.1 mL/kg; p=0.008). Vt was lower in infants who died during admission or had CLD (n=20) compared with survivors without CLD (n=10) (2.0±1.7 vs 4.3±2.2 mL/kg; p=0.004). ROC analysis showed that Vt ≤2.2 mL/kg predicted mortality with 79% sensitivity and 81% specificity (AUC=0.77, p=0.013). Vt ≤3.4 mL/kg was a good predictor of death or CLD (AUC=0.80, p=0.008) with 85% sensitivity and 70% specificity.Conclusion Vt of spontaneous breaths measured immediately after birth is associated with mortality and CLD. Vt seems to be a reliable predictor but is not an independent predictor after adjustment for observed/expected lung to head ratio and liver position.