■尽管新生儿重症监护取得了进展,手术方法,和麻醉,先天性膈疝(CDH)仍然与显著的死亡率相关.预测哪些婴儿的预后较差对于识别高风险婴儿并为父母提供有针对性的护理和准确的预后至关重要。尤其是在资源紧缩的情况下。
■这项研究的目的是评估可用于预测结局的新生儿CDH的产前和产后预后因素。
■这是一项在三级护理中心进行的前瞻性观察性研究。
■在28天内出现CDH的新生儿被纳入研究。双侧疾病,复发性疾病,在室外手术的婴儿被排除在研究之外。数据是前瞻性收集的,婴儿被跟踪直到出院或死亡。
■数据以具有标准偏差的平均值或具有基于正态的范围的中值表示。所有数据使用SPSS软件版本25进行分析。
■研究了30例新生儿CDH。有三个右边的案例。男女比例为2.3:1,93%的婴儿是在产前诊断的。30名婴儿中有17名接受了手术。9人(52.9%)接受了剖腹手术,8例(47%)接受胸腔镜修复。总死亡率为53.3%,手术死亡率为17.6%。过期婴儿与存活婴儿之间的人口统计学特征具有可比性。确定的结果的重要预测因子是-持续性肺动脉高压(PPHN),网格修复,高频振荡通气(HFOV),使用直角天线,5分钟APGAR,呼吸机指数(VI),和HCO3水平。
■我们得出结论,与不良预后相关的预后指标是5分钟APGAR低,高VI,静脉血气分析中HCO3水平低,网格修复,HFOV,同向异构体的使用,和PPHN。所研究的产前因素均无统计学意义。建议使用更大样本量的进一步前瞻性研究来确认发现。
UNASSIGNED: Despite advances in neonatal intensive care, surgical methods, and anesthesia, congenital diaphragmatic hernia (CDH) is still associated with significant mortality. Predicting which babies will have poorer outcomes is essential to identify the high-risk babies and to give targeted care and accurate prognosis to the parents, especially in a resource crunch set-up.
UNASSIGNED: The aim of this study is to evaluate the antenatal and postnatal prognostic factors in neonatal CDH that can be used to predict the outcome.
UNASSIGNED: This was a prospective observational study in a tertiary care center.
UNASSIGNED: Neonates presented with CDH within 28 days of life were included in the study. Bilateral disease, recurrent diseases, and babies operated outside were excluded from the study. The data were collected prospectively, and babies were followed until discharge or death.
UNASSIGNED: Data were expressed in mean with standard deviation or median with range based on normality. All the data were analyzed using the SPSS software version 25.
UNASSIGNED: Thirty babies with neonatal CDH were studied. There were three right-sided cases. The male-to-female ratio was 2.3:1, and 93% of babies were antenatally diagnosed. Seventeen out of the 30 babies underwent surgery. Nine (52.9%) underwent laparotomy, and 8 (47%) underwent thoracoscopic repair. Overall mortality was 53.3%, and operative mortality was 17.6%. Demographic characteristics were comparable between expired versus survived babies. The significant predictors of outcome identified were - Persistent pulmonary hypertension (PPHN), mesh repair, high-frequency oscillatory ventilation (HFOV), use of inotropes, 5-min APGAR, ventilator index (VI), and HCO3 levels.
UNASSIGNED: We conclude that the prognostic indicators associated with poor prognosis are low 5-min APGAR, high VI, low HCO3 levels in venous blood gas analysis, mesh repair, HFOV, inotropes usage, and PPHN. None of the antenatal factors studied showed any statistical significance. Further prospective studies with a larger sample size are recommended to confirm the findings.