Lü Junjian,Lin Tulian,Wu Qiang,et al.Prediction of extracorporeal membrane oxygenation in children with congenital diaphragmatic hernia by echocardiography[J].Journal of Clinical Pediatric Surgery,,20():814-818,824.[doi:10.12260/lcxewkzz.2021.09.003]
Prediction of extracorporeal membrane oxygenation in children with congenital diaphragmatic hernia by echocardiography
- Keywords:
- Hernias; Diaphragmatic; Congenital/DI; Ultrasonography; Prenatal; Extracorporeal Membrane Oxygenation; Prognosis
- CLC:
- R655.6;R540.45
- Abstract:
- Objective To explore the predictive value of echocardiography in the treatment of congenital diaphragmatic hernia (CDH) with extracorporeal membrane oxygenation (ECMO).Methods From January 2017 to December 2020, clinical data were retrospectively reviewed for 77 CDH children.According to whether or not fulfilling the indications for adjuvant treatment with ECMO, they were divided into two groups of non-ECMO (n=58) and ECMO (n=19).The relationship between was examined between the need to receive ECMO adjuvant therapy and such general profiles as gestational age, birth weight, gender and affected sidenia, etc.And the postnatal predictive effect of echocardiography within 24 hours on the acceptance of ECMO therapy in CDH children.Results No significant inter-group differences existed in gender, birth weight, gestational age, affected side, prenatal diagnosis, atrial horizontal shunt (AHS), right ventricular diameter (RVD), main pulmonary artery diameter (MPAD), left ventricular fractional shortening (LVFS) or left ventricular ejection fraction (LVEF) (P>0.05).The inter-group differences of hepatic hernia, persistent pulmonary hypertension of newborn (PPHN), patent ductus arteriosus (PDA), aortic diameter (AOD), left atrial diameter (LAD), left ventricular end-systolic diameter (LVESD) and left ventricular end-diastolic diameter (LVEDD) on echocardiography were statistically significant (P<0.05).Stepwise regression analysis indicated that hepatic hernia (OR=25.83, 95%CI:1.46-456.26), higher PDA (OR=3.33, 95%CI:1.03-10.81) and lower LAD (OR=0.18, 95%CI:0.05-0.67) were independent risk factors for ECMO (P<0.05).The area under ROC curve of PDA value for requiring ECMO treatment was 0.890(95%CI:0.815-0.964, P<0.01) and the sensitivity and specificity were 100% and 61.02% with a PDA of 3.1 mm;The area under receiver operating characteristic (ROC) curve of LAD value for requiring ECMO treatment was 0.830(95%CI:0.722-0.937, P<0.01) and the sensitivity and specificity of ECMO treatment were 61.11% and 93.22% with a LAD of 7.5 mm.Conclusion Postnatal echocardiography may predict the need for ECMO in CDH children and assist in clinical decision-making.
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Memo
收稿日期:2020-05-18。
基金项目:广东省自然科学基金-面上项目（编号：2020A1515010296）
通讯作者:钟微,Email:zhongwei@gwcmc.org