Ferreira et al studied neonates undergoing thoracoscopic primary repair of congenital diaphragmatic hernia (CDH). They identified risk factors associated with failure of primary repair. The authors are from multiple pediatric hospitals in France.
Patient selection: neonate with congenital diaphragmatic hernia
Outcome: failure of primary repair defined as either required conversion to patch closure or major complications.
persistent pulmonary hypertension of the newborn (PPHN)
Echocardiographic signs of PPHN:
(1) right-to-left PDA
(2) left-to-right deformation of the interventricular septum
(3) tricuspid valve insufficiency
oxygenation index = OI =
= 100 * FIO2 * MAP / PaO2
The OI is calculated after 24 hours of respiratory and ventilatory stability.
The only factor associated with failure of primary repair on multivariate analysis was an OI > 3.
Additional factors found on univariate analysis:
(1) PaCO2 at birth > 60 mm Hg
(2) need for inhaled nitric oxide for the first 24 hours
(3) intra-thoracic stomach on X-ray
(4) bidirectional PDA or right-to-left shunt
