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Background: Despite improvements in clinical management, mortality of congenital diaphragmatic hernia (CDH) remains high. Early prediction of mortality risk helps in comparing strategies and/or performances of different centers. Birth weight (BW), Apgar Score at 5 minutes, and modified McGoon Index (MGI) calculated by the ratio between the diameters of pulmonary arteries and the descending aorta have been used to determine mortality of CDH., Aim: The purpose of this study is to evaluate the relationship between early detectable variables and survival in newborns with CDH intubated at birth, managed with "gentle" ventilation and delayed surgery., Methods: All medical records of patients affected by high-risk CDH and treated with a standardized protocol at Bambino Gesù Children's Hospital, Rome, Italy, between January 2002 and September 2004 were reviewed. Prenatal diagnosis, gestational age, BW, sex, side of hernia, and MGI were recorded on admission. The relationship with mortality of each variable was evaluated by univariate analysis. Subsequently, a predictive model of mortality was developed using a logistic regression: the explanatory variables, BW, and MGI were dichotomized in high (HBW and HMGI) and low (LBW and LMGI) according to the best cutoff found with receiver-operating characteristic curves., Results: Thirty-four newborns with CDH, treated with a standardized protocol, were studied. The main characteristics of the 34 patients were BW, 2886 g (1500-3620 g); gestational age, 37.7 weeks (32-42 weeks); male/female, 22/12; right/left, 8/26; prenatal diagnosis, 29; MGI, 1.31 (0.9-1.85). Only BW and MGI were significantly (P < .05) associated with mortality at the univariate analysis. The best cutoff values were 2755 g for BW (sensitivity, 70%; specificity, 74%) and 1.25 for MGI (sensitivity, 73%; specificity, 78%). Using these limits, BW and MGI resulted independently associated with mortality in the multivariate analysis. Using the 4 possible combinations, the LBW associated with the LMGI presented the highest prediction of mortality (80%)., Conclusions: Birth weight and MGI, variously combined, were predictive of mortality. Because they are not influenced by subsequent modalities of care, they can be considered as valid early severity scores in CDH and used for comparing strategies and/or performances of different centers.

Objective: The aim of this study was to improve the definition of birth weight discordancy based on its distribution in the population after a correction in the unlike sex pairs., Study Design: The analysis was conducted on 849 Italian twin pairs. Male's birth weight in the unlike sex pairs was corrected by the physiological birth weight difference estimated on 21.595 Italian twins data. Birth weight discordancy was computed as a percentage of the larger twin's birth weight and it was compared by sex pairs and by gestational ages (Kruskal-Wallis test). Kolmogorov-Smirnov test was used to fit a normal distribution to the square-root transformed birth weight discordancy., Results: The estimated physiological birth weight difference between males and females was 4.39%, without any difference among gestational ages. The 90th centile of birth weight discordancy was 23.9% and the 95th centile was 29.2%., Conclusions: Ninetieth and 95th centiles of the fitted distribution are proposed as cut-off values for the definition of mild and severe birth weight discordancy.

11 923 singletons with birthweight greater than 775 g born consecutively at the 2nd School of Medicine of Naples during a four-year period (November 1975 to October 1979) were the subjects of the study. Mortality in the first week of life was 10.9, 9.7, 6.7 and 10.7 per 1 000 respectively in the four years. The total variability of the crude death rates was reduced by 21.4% after standardization for birthweight distribution alone and by 28.6% when both birthweight and mode of delivery were taken into account. Therefore only a small fraction of the variations in mortality can be ascribed to changes in the distribution of modes of delivery during the study period. Most of these variations are probably related to the quality of perinatal care, which seems to have improved only for babies under 1 526 g. Birthweight specific mortality in relation to mode of delivery is further discussed.

Six Italian university centers have taken part in the Perinatal Preventive Medicine Project of the National Research Council since 1973. In this report the preliminary data on neonatal neurological disorders of 38775 single not malformed infants are presented. Neurological abnormality has been defined by the presence of at least one of the following symptoms: seizures, hypertonia, hypotonia, apneic spells. The relative frequencies of seizures vary from a minimum of 0.28% to a maximum of 0.75% in the six centers. The frequencies of the other symptoms demonstrate a greater variability among centers. Males are more affected than females. The relative frequency of neurological abnormalities is higher among babies with low birthweight, short gestational age or retarded intrauterine growth. Also, the frequency of seizures is higher among babies with low birthweight or retarded intrauterine growth while the relationship between seizures and gestational age is not clear.