Perioperative assessment of respiratory compliance and lung volume in infants with congenital diaphragmatic hernia: prediction of outcome.

BACKGROUND/PURPOSE: Infants who have congenital diaphragmatic hernia (CDH) have high mortality and morbidity. The aim of this study was to determine the relative ability of the results of serial measurements of compliance of the respiratory system (CRS) and lung volume (functional residual capacity (FRC)) to predict poor outcome: death or oxygen dependency at 28 days. In addition, the authors wished to document the evolution of any lung function abnormalities during the perioperative period.

METHODS: Daily measurements of CRS and FRC were made in the first week of life and subsequently during week 2 in 16 infants who had a median gestational age of 38 weeks and birth weight of 3.2 kg.

RESULTS: Seven infants had a poor outcome: five died and two others remained oxygen dependent beyond 28 days. The infants who had a poor outcome were characterized on day 1 by a significantly lower CRS, but not FRC (P < .05). In comparison with results from day 1, the median CRS of the infants overall had significantly improved only by week 2 (P < .05), there was no such significant change in FRC with increasing postnatal age. At week 2, only the CRS results differed significantly between those infants who had and who did not have poor outcome (P < .05).

CONCLUSION: The results of serial measurements of CRS, rather than FRC are the more useful predictor of outcome in infants who have CDH.