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O-097 Clinical Score To Predict Outcome In Congenital Diaphragmatic Hernia; Results Obtained From An International Multicenter Study
  1. KG Snoek1,
  2. I Capolupo2,
  3. F Morini2,
  4. RMH Wijnen1,
  5. IKM Reiss3,
  6. P Bagolan2,
  7. H IJsselstijn1,
  8. D Tibboel1
  1. 1Department of Paediatric Surgery and Intensive Care, Erasmus MC Sophia Children’s Hospital, Rotterdam, Netherlands
  2. 2Department of Medical and Surgical Neonatology, Bambino Gesu Children’s Hospital, Rome, Italy
  3. 3Department of Neonatology, Erasmus MC Sophia Children’s Hospital, Rotterdam, Netherlands

Abstract

Background In congenital diaphragmatic hernia (CDH) reliable postnatal predictors of outcome are scarce. Score for Neonatal Acute Physiology-II (SNAP-II) (Richardson, 2001) has been validated to predict mortality in newborns. We hypothesised that higher SNAP-II scores are found in non-survivors, those who need extracorporeal membrane oxygenation (ECMO), and those who develop chronic lung disease (CLD), defined as oxygen dependency at day 28.

Methods In a prospective, randomised controlled multicenter trial initiated by the Euroconsortium (VICI-trial, NTR 1310), neonates born between November 2008 and December 2013, were randomised for initial ventilation strategy (either high-frequency oscillation or conventional mechanical ventilation). Prenatal, perinatal and postnatal data including SNAP-II scores were collected. Mann-Whitney U test was used for analyses. Data were presented as n (%) and median (IQR).

Results Of the 173 included patients, 46 patients (26.6%) died, 39 (22.5%) underwent ECMO, and 38 patients (29.9%) of the survivors developed CLD. Overall, the SNAP-II score was 22.5 (10 to 37). In non-survivors SNAPP-II score was 40.0 (32.0 to 54.5) and 16.5 (7.8 to 26.5) in survivors (p < 0.001). It was 35.0 (30.0 to 46.0) in ECMO treated patients and 19.0 (9.0 to 32.0) in patients without ECMO need (p < 0.001). Survivors with CLD had SNAP-II score of 25.5 (21.0 to 35.5) and those without CLD 13.0 (5.0 to21.0) (p < 0.001).

Conclusions In this prospective multicenter study, we showed that in CDH patients SNAP-II scores may not only be useful to predict mortality but also to identify patients who need ECMO or are at risk for development of CLD.

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