Predicting death or extended length of stay in infants with congenital diaphragmatic hernia
| Autor: | Billie L. Short, Michael A. Padula, Jeanette M. Asselin, Theresa R. Grover, Isabella Zaniletti, Francine D. Dykes, Natalie E. Rintoul, Beverly S. Brozanski, Karna Murthy, Kristina M. Reber, Jason Gien, Jaquelyn Evans, David J. Durand, Louis G. Chicoine, Nicolas F M Porta, Sarah Keene, Eugenia K. Pallotto |
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| Rok vydání: | 2016 |
| Předmět: |
Male
medicine.medical_specialty Multivariate analysis Databases Factual MEDLINE Diaphragmatic breathing Gestational Age 03 medical and health sciences 0302 clinical medicine Intensive Care Units Neonatal 030225 pediatrics Odds Ratio medicine Humans 030212 general & internal medicine Neonatology Retrospective Studies Obstetrics business.industry Infant Newborn Infant Obstetrics and Gynecology Gestational age Congenital diaphragmatic hernia Retrospective cohort study Odds ratio Length of Stay medicine.disease United States digestive system diseases stomatognathic diseases Logistic Models surgical procedures operative Multivariate Analysis Pediatrics Perinatology and Child Health Female Risk Adjustment Hernias Diaphragmatic Congenital business |
| Zdroj: | Journal of Perinatology. 36:654-659 |
| ISSN: | 1476-5543 0743-8346 |
| DOI: | 10.1038/jp.2016.26 |
| Popis: | To predict mortality or length of stay (LOS)109 days (90th percentile) among infants with congenital diaphragmatic hernia (CDH).We conducted a retrospective analysis using the Children's Hospital Neonatal Database during 2010 to 2014. Infants born34 weeks gestation with CDH admitted at 22 participating regional neonatal intensive care units were included; patients who were repaired or were at home before admission were excluded. The primary outcome was death before discharge or LOS109 days. Factors associated with this outcome were used to develop a multivariable equation using 80% of the cohort. Validation was performed in the remaining 20% of infants.The median gestation and age at referral in this cohort (n=677) were 38 weeks and 6 h, respectively. The primary outcome occurred in 242 (35.7%) infants, and was distributed between mortality (n=180, 27%) and LOS109 days (n=66, 10%). Regression analyses showed that small for gestational age (odds ratio (OR) 2.5, P=0.008), presence of major birth anomalies (OR 5.9, P0.0001), 5- min Apgar score ⩽3 (OR 7.0, P=0.0002), gradient of acidosis at the time of referral (P0.001), the receipt of extracorporeal support (OR 8.4, P0.0001) and bloodstream infections (OR 2.2, P=0.004) were independently associated with death or LOS109 days. This model performed well in the validation cohort (area under curve (AUC)=0.856, goodness-of-fit (GF) χ(2), P=0.16) and acted similarly even after omitting extracorporeal support (AUC=0.82, GF χ(2), P=0.05).Six variables predicted death or LOS ⩾109 days in this large, contemporary cohort with CDH. These results can assist in risk adjustment for comparative benchmarking and for counseling affected families. |
| Databáze: | OpenAIRE |
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