Download PDF
Eur J Pediatr Surg 2016; 26(04): 316-321
DOI: 10.1055/s-0035-1554103
Original Article
Georg Thieme Verlag KG Stuttgart · New York

SNAPPE II Score As a Predictor of Survival in Neonates with Congenital Diaphragmatic Hernia: A Single Center Experience

Louisa W. Chiu
1   Department of Pediatric Surgery, Children's Hospital of Michigan, Detroit, Michigan, United States
2   Department of Surgery, Baylor College of Medicine, Houston, Texas, United States
,
Jagdish Desai
3   Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Children's Hospital of Michigan/Wayne State University, Detroit, Michigan, United States
,
Christina Shanti
1   Department of Pediatric Surgery, Children's Hospital of Michigan, Detroit, Michigan, United States
,
Sharayu Rane
3   Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Children's Hospital of Michigan/Wayne State University, Detroit, Michigan, United States
,
Prashant Agarwal
3   Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Children's Hospital of Michigan/Wayne State University, Detroit, Michigan, United States
,
Ronald Lee Thomas
4   Department of Biostatistics, Children's Research Center of Michigan, Wayne State University, Detroit, Michigan, United States
,
Michael Klein
1   Department of Pediatric Surgery, Children's Hospital of Michigan, Detroit, Michigan, United States
,
Nitin Shashikant Chouthai
3   Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Children's Hospital of Michigan/Wayne State University, Detroit, Michigan, United States
› Author Affiliations
Further Information

Publication History

06 February 2015

31 March 2015

Publication Date:
12 August 2015 (online)

    Permissions and Reprints

Abstract

Introduction Prediction of mortality and morbidity in newborns with congenital diaphragmatic hernia (CDH) is too complex for practical use and may not be accurate. The main objective of this study was to evaluate the usefulness of the CDH Study Group equation and Score of Neonatal Acute Physiology Perinatal Extension (SNAPPE) II score to predict short-term outcomes of newborns with CDH.

Materials and Methods Fifty-two neonates were admitted with CDH at Children's Hospital of Michigan from November 2001 to July 2009. Retrospective chart analysis was performed. Predicted survival rates were calculated using the equation published by the CDH Study Group in 2001. SNAPPE II scores were also obtained within 12 hours of admission. Statistical analysis was performed using SPSS statistical package.

Results Thirty out of 52 (58%) neonates survived to discharge. SNAPPE II score was significantly lower (p < 0.0001) in survivors (20 ± 15) versus nonsurvivors (41 ± 16). When neonates were stratified according to the CDH Study Group, low-risk patients had a survival rate of 68% (predicted 84%), moderate-risk patients had a survival rate of 43% (predicted 57%), and high-risk patients had a survival rate of 33% (predicted 36%). A total of 83% of the newborns who survived were operated within 48 hours of life, while only 17% of the nonsurvivors were operated within 48 hours of life.

Conclusion SNAPPE II scores were better predictors of mortality than the CDH Study Group equation published in 2001. Further exploration is warranted to evaluate validity of survival advantage for those who were operated within 48 hours of life. A future study of combination of prenatal and postnatal factors may help in improved outcomes of the newborns with CDH.

Keywords

congenital diaphragmatic hernia - predictors of mortality - SNAPPE II score
 

  • References

  • 1 Desfrere L, Jarreau PH, Dommergues M , et al. Impact of delayed repair and elective high-frequency oscillatory ventilation on survival of antenatally diagnosed congenital diaphragmatic hernia: first application of these strategies in the more “severe” subgroup of antenatally diagnosed newborns. Intensive Care Med 2000; 26 (7) 934-941
    CrossrefPubMedGoogle Scholar
  • 2 Bagolan P, Casaccia G, Crescenzi F, Nahom A, Trucchi A, Giorlandino C. Impact of a current treatment protocol on outcome of high-risk congenital diaphragmatic hernia. J Pediatr Surg 2004; 39 (3) 313-318 , discussion 313–318
    CrossrefPubMedGoogle Scholar
  • 3 Datin-Dorriere V, Walter-Nicolet E, Rousseau V , et al. Experience in the management of eighty-two newborns with congenital diaphragmatic hernia treated with high-frequency oscillatory ventilation and delayed surgery without the use of extracorporeal membrane oxygenation. J Intensive Care Med 2008; 23 (2) 128-135
    CrossrefPubMedGoogle Scholar
  • 4 Migliazza L, Bellan C, Alberti D , et al. Retrospective study of 111 cases of congenital diaphragmatic hernia treated with early high-frequency oscillatory ventilation and presurgical stabilization. J Pediatr Surg 2007; 42 (9) 1526-1532
    CrossrefPubMedGoogle Scholar
  • 5 Reyes C, Chang LK, Waffarn F, Mir H, Warden MJ, Sills J. Delayed repair of congenital diaphragmatic hernia with early high-frequency oscillatory ventilation during preoperative stabilization. J Pediatr Surg 1998; 33 (7) 1010-1014 , discussion 1014–1016
    CrossrefPubMedGoogle Scholar
  • 6 Boloker J, Bateman DA, Wung JT, Stolar CJ. Congenital diaphragmatic hernia in 120 infants treated consecutively with permissive hypercapnea/spontaneous respiration/elective repair. J Pediatr Surg 2002; 37 (3) 357-366
    CrossrefPubMedGoogle Scholar
  • 7 Skari H, Bjornland K, Haugen G, Egeland T, Emblem R. Congenital diaphragmatic hernia: a meta-analysis of mortality factors. J Pediatr Surg 2000; 35 (8) 1187-1197
    CrossrefPubMedGoogle Scholar
  • 8 Wilson JM, Fauza DO, Lund DP, Benacerraf BR, Hendren WH. Antenatal diagnosis of isolated congenital diaphragmatic hernia is not an indicator of outcome. J Pediatr Surg 1994; 29 (6) 815-819
    CrossrefPubMedGoogle Scholar
  • 9 Fauza DO, Wilson JM. Congenital diaphragmatic hernia and associated anomalies: their incidence, identification, and impact on prognosis. J Pediatr Surg 1994; 29 (8) 1113-1117
    CrossrefPubMedGoogle Scholar
  • 10 Shaw KS, Filiatrault D, Yazbeck S, St-Vil D. Improved survival for congenital diaphragmatic hernia, based on prenatal ultrasound diagnosis and referral to a combined obstetric-pediatric surgical center. J Pediatr Surg 1994; 29 (9) 1268-1269
    CrossrefPubMedGoogle Scholar
  • 11 Keshen TH, Gursoy M, Shew SB , et al. Does extracorporeal membrane oxygenation benefit neonates with congenital diaphragmatic hernia? Application of a predictive equation. J Pediatr Surg 1997; 32 (6) 818-822
    CrossrefPubMedGoogle Scholar
  • 12 Bohn D, Tamura M, Perrin D, Barker G, Rabinovitch M. Ventilatory predictors of pulmonary hypoplasia in congenital diaphragmatic hernia, confirmed by morphologic assessment. J Pediatr 1987; 111 (3) 423-431
    CrossrefPubMedGoogle Scholar
  • 13 Bailey PV, Connors RH, Tracy Jr TF, Stephens C, Pennington DG, Weber TR. A critical analysis of extracorporeal membrane oxygenation for congenital diaphragmatic hernia. Surgery 1989; 106 (4) 611-615 , discussion 616
    PubMedGoogle Scholar
  • 14 Wilson JM, Lund DP, Lillehei CW, Vacanti JP. Congenital diaphragmatic hernia: predictors of severity in the ECMO era. J Pediatr Surg 1991; 26 (9) 1028-1033 , discussion 1033–1034
    CrossrefPubMedGoogle Scholar
  • 15 Haricharan RN, Barnhart DC, Cheng H, Delzell E. Identifying neonates at a very high risk for mortality among children with congenital diaphragmatic hernia managed with extracorporeal membrane oxygenation. J Pediatr Surg 2009; 44 (1) 87-93
    CrossrefPubMedGoogle Scholar
  • 16 Schultz CM, DiGeronimo RJ, Yoder BA ; Congenital Diaphragmatic Hernia Study Group. Congenital diaphragmatic hernia: a simplified postnatal predictor of outcome. J Pediatr Surg 2007; 42 (3) 510-516
    CrossrefPubMedGoogle Scholar
  • 17 Numanoglu A, Morrison C, Rode H. Prediction of outcome in congenital diaphragmatic hernia. Pediatr Surg Int 1998; 13 (8) 564-568
    CrossrefPubMedGoogle Scholar
  • 18 Touloukian RJ, Markowitz RI. A preoperative x-ray scoring system for risk assessment of newborns with congenital diaphragmatic hernia. J Pediatr Surg 1984; 19 (3) 252-257
    CrossrefPubMedGoogle Scholar
  • 19 Casaccia G, Crescenzi F, Dotta A , et al. Birth weight and McGoon Index predict mortality in newborn infants with congenital diaphragmatic hernia. J Pediatr Surg 2006; 41 (1) 25-28 , discussion 25–28
    CrossrefPubMedGoogle Scholar
  • 20 Suda K, Bigras JL, Bohn D, Hornberger LK, McCrindle BW. Echocardiographic predictors of outcome in newborns with congenital diaphragmatic hernia. Pediatrics 2000; 105 (5) 1106-1109
    CrossrefPubMedGoogle Scholar
  • 21 Seetharamaiah R, Younger JG, Bartlett RH, Hirschl RB ; Congenital Diaphragmatic Hernia Study Group. Factors associated with survival in infants with congenital diaphragmatic hernia requiring extracorporeal membrane oxygenation: a report from the Congenital Diaphragmatic Hernia Study Group. J Pediatr Surg 2009; 44 (7) 1315-1321
    CrossrefPubMedGoogle Scholar
  • 22 Muratore CS, Kharasch V, Lund DP , et al. Pulmonary morbidity in 100 survivors of congenital diaphragmatic hernia monitored in a multidisciplinary clinic. J Pediatr Surg 2001; 36 (1) 133-140
    CrossrefPubMedGoogle Scholar
  • 23 Lessin MS, Thompson IM, Deprez MF, Cullen ML, Whittlesey GC, Klein MD. Congenital diaphragmatic hernia with or without extracorporeal membrane oxygenation: are we making progress?. J Am Coll Surg 1995; 181 (1) 65-71
    PubMedGoogle Scholar
  • 24 Chu JM, Tsou Yau KI, Lai HS, Chen WJ, Hung WT, Chen CC. Congenital diaphragmatic hernia: analysis on factors affecting survival. Zhonghua Min Guo Xiao Er Ke Yi Xue Hui Za Zhi 1991; 32 (6) 341-347
    PubMedGoogle Scholar
  • 25 Chou HC, Tang JR, Lai HS, Tsao PN, Yau KI. Prognostic indicators of survival in infants with congenital diaphragmatic hernia. J Formos Med Assoc 2001; 100 (3) 173-175
    PubMedGoogle Scholar
  • 26 Congenital Diaphragmatic Hernia Study Group. Estimating disease severity of congenital diaphragmatic hernia in the first 5 minutes of life. J Pediatr Surg 2001; 36 (1) 141-145
    CrossrefPubMedGoogle Scholar
  • 27 Richardson DK, Corcoran JD, Escobar GJ, Lee SK. SNAP-II and SNAPPE-II: simplified newborn illness severity and mortality risk scores. J Pediatr 2001; 138 (1) 92-100
    CrossrefPubMedGoogle Scholar
  • 28 Geary MP, Chitty LS, Morrison JJ, Wright V, Pierro A, Rodeck CH. Perinatal outcome and prognostic factors in prenatally diagnosed congenital diaphragmatic hernia. Ultrasound Obstet Gynecol 1998; 12 (2) 107-111
    CrossrefPubMedGoogle Scholar
  • 29 Fumino S, Shimotake T, Kume Y , et al. A clinical analysis of prognostic parameters of survival in children with congenital diaphragmatic hernia. Eur J Pediatr Surg 2005; 15 (6) 399-403
    Article in Thieme ConnectPubMedGoogle Scholar
  • 30 Moore A, Umstad MP, Stewart M, Stokes KB. Prognosis of congenital diaphragmatic hernia. Aust N Z J Obstet Gynaecol 1998; 38 (1) 16-21
    CrossrefPubMedGoogle Scholar
  • 31 Harrison MR, Adzick NS, Estes JM, Howell LJ. A prospective study of the outcome for fetuses with diaphragmatic hernia. JAMA 1994; 271 (5) 382-384
    CrossrefPubMedGoogle Scholar
  • 32 Adzick NS, Vacanti JP, Lillehei CW, O'Rourke PP, Crone RK, Wilson JM. Fetal diaphragmatic hernia: ultrasound diagnosis and clinical outcome in 38 cases. J Pediatr Surg 1989; 24 (7) 654-657 , discussion 657–658
    CrossrefPubMedGoogle Scholar
  • 33 Kitano Y, Nakagawa S, Kuroda T , et al. Liver position in fetal congenital diaphragmatic hernia retains a prognostic value in the era of lung-protective strategy. J Pediatr Surg 2005; 40 (12) 1827-1832
    CrossrefPubMedGoogle Scholar
  • 34 Bedoyan JK, Blackwell SC, Treadwell MC, Johnson A, Klein MD. Congenital diaphragmatic hernia: associated anomalies and antenatal diagnosis. Outcome-related variables at two Detroit hospitals. Pediatr Surg Int 2004; 20 (3) 170-176
    CrossrefPubMedGoogle Scholar
  • 35 Clark RH, Hardin Jr WD, Hirschl RB , et al. Current surgical management of congenital diaphragmatic hernia: a report from the Congenital Diaphragmatic Hernia Study Group. J Pediatr Surg 1998; 33 (7) 1004-1009
    CrossrefPubMedGoogle Scholar
  • 36 Pollack MM, Koch MA, Bartel DA , et al. A comparison of neonatal mortality risk prediction models in very low birth weight infants. Pediatrics 2000; 105 (5) 1051-1057
    CrossrefPubMedGoogle Scholar
  • 37 Skarsgard ED, MacNab YC, Qiu Z, Little R, Lee SK ; Canadian Neonatal Network. SNAP-II predicts mortality among infants with congenital diaphragmatic hernia. J Perinatol 2005; 25 (5) 315-319
    CrossrefPubMedGoogle Scholar
  • 38 Metkus AP, Filly RA, Stringer MD, Harrison MR, Adzick NS. Sonographic predictors of survival in fetal diaphragmatic hernia. J Pediatr Surg 1996; 31 (1) 148-151 , discussion 151–152
    CrossrefPubMedGoogle Scholar
  • 39 Laudy JA, Van Gucht M, Van Dooren MF, Wladimiroff JW, Tibboel D. Congenital diaphragmatic hernia: an evaluation of the prognostic value of the lung-to-head ratio and other prenatal parameters. Prenat Diagn 2003; 23 (8) 634-639
    CrossrefPubMedGoogle Scholar
  • 40 Jani J, Nicolaides KH, Keller RL , et al; Antenatal-CDH-Registry Group. Observed to expected lung area to head circumference ratio in the prediction of survival in fetuses with isolated diaphragmatic hernia. Ultrasound Obstet Gynecol 2007; 30 (1) 67-71
    CrossrefPubMedGoogle Scholar
  • 41 Lally KP, Lasky RE, Lally PA , et al; Congenital Diaphragmatic Hernia Study Group. Standardized reporting for congenital diaphragmatic hernia—an international consensus. J Pediatr Surg 2013; 48 (12) 2408-2415
    CrossrefPubMedGoogle Scholar
  • 42 Schwartz SM, Vermilion RP, Hirschl RB. Evaluation of left ventricular mass in children with left-sided congenital diaphragmatic hernia. J Pediatr 1994; 125 (3) 447-451
    CrossrefPubMedGoogle Scholar
  • 43 Baumgart S, Paul JJ, Huhta JC , et al. Cardiac malposition, redistribution of fetal cardiac output, and left heart hypoplasia reduce survival in neonates with congenital diaphragmatic hernia requiring extracorporeal membrane oxygenation. J Pediatr 1998; 133 (1) 57-62
    CrossrefPubMedGoogle Scholar