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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