60 Birthweight and Mcgoon Index Predict Outcome in Newborn Infants with Congenital Diaphragmatic Hernia (CDH).

Background: Birth weight (BW), Gestational age (GA), Apgar score at 5 minutes, prenatal diagnosis (PD), gender (M/F), side of hernia (R/L) and McGoon Index (MGI) (i.e. The ratio between the sum of the diameters of the 2 pulmonary arteries and that of the descending aorta), have been utilized to determine the severity and prognosis of CDH.Aim: To evaluate the relationship between the above mentioned variables recorded on admission and survival in infants with CDH..Methods: 34 consecutive newborns with CDH (BW=2886 g, [range 1500–3620], GA=37.7 weeks [32–42], M/F=22/12, Right/Left CDH=8/26, PD=29; MGI=1.31 [0.9–1.85]), all managed according to a standardized protocol (including intubation at birth, gentle ventilation and delayed surgery), were studied. The relationship between the above mentioned variables and mortality was first evaluated by univariate analysis. BW and MGI were classified as high (HBW and HMGI) and low (LBW and LMGI) according to the best cut-off values identified by ROC curves: i.e. 2755 g for BW (sensitivity 70%, specificity 74%), and 1.25 for MGI (sensitivity 73%, specificity 78%). A predictive model of mortality was then developed using a logistic regression analysis.Results: Only BW and MGI were significantly (p<0.05) and indipendently associated with mortality at the univariate and multivariate analysis: ORs=7.2 (95%CI=1.1–47.8) for BW and 9.1 (95%CI=1.4–60.1) for MGI. According to the 4 possible combinations of the two dichotomized variables the mortality rates were: HBW+HMGI = 6% ; HBW+LMGI = 31% ; LBW+HMGI = 36% ; LBW+LMGI =80%.Conclusions: Since BW and MGI on admission are not influenced by subsequent modalities of care, they can be considered early and reliable severity scores in CDH and utilized for evaluating new therapeutic strategies and/or for comparing performances among different centres.(Supported by Grant N 02P000631 of the Italian Ministry of Health).