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ULTRASOUND PREDICTORS OF SURVIVAL IN NEWBORNS WITH A LEFT SIDE CONGENITAL DIAPHRAGMATIC HERNIA

Introduction. Complex ultrasound diagnosis of the organ and, directly, cardiac function allows forming groups of prognostically significant risk factors for the development of complications in newborns with a congenital diaphragmatic hernia (CDH) and on their basis to select patients with the negative life expectancy. The determination of hemodynamic disorders as secondary ones will allow emphasizing the treatment on the elimination of the main pathology, which will lead to an improvement and/or normalization of cardiac activity. The aim of the work is to identify ultrasound markers of risk factors for complications in CDH newborns. Material and methods. In 32 left side CDH newborns at the age of 6-18 h of the 1st day of the life, there was performed an examination on the expanded echographic protocol. The indices studied included the end-diastolic volume (EDV) of the left ventricle (LV) indexed to the surface area of the body; the mass of the myocardium (MM) of the LV; index of the shape (IS) of the LV; the ratio of the pulmonary blood flow to the systemic (Qp/Qs); cardiac index (CI); the McGun index; the ratio of the systolic blood pressure (SBP) in the pulmonary artery (PA) to systemic arterial pressure (SAP); the ratio of the time of the systole to the time of the diastole of the right ventricle (RV); a marker of the total myocardial contractility; the presence of organs of the abdominal cavity in the pleural cavities on the affected side (the proportion of the liver, stomach, spleen). The results of the extended echocardiographic examination were correlated with the clinical data characterizing the severity of the patient’s condition in the perioperative period (duration of the artificial ventilation, the need for cardiotonic and inotropic therapy, the length of the stay in the hospital), the outcome of the disease after surgery. Results. The overall survival rate of CDH newborns was 78.2%. EDV, MM, IS, CI and the ratio of systolic pressure in the pulmonary artery to systemic blood pressure in the groups of deceased and surviving patients significantly differed on the 1st day of the life (p = 0.013, p = 0.037, p = 0.001 and p = 0.04, respectively ). Within the framework of binary logistic regression, only CI affects the outcome of the treatment of CDH newborns (OR = 43.8 at p = 0.029). CI less than 2 L/min/m2 is a predictor of death of CDH newborns. EDV (less than 26 ml/m2), MM (less than 37g/m2), the ratio of systolic pressure in the pulmonary artery to systemic blood pressure (more than 0.9) are additional markers affecting on the outcome of treatment for CDH newborns. Conclusion. CI is an independent index in predicting the outcome of the treatment of CDH newborns (OR = 43.8 at p = 0.029). EDV, MM, the ratio of systolic pressure in the pulmonary artery to systemic BP are additional markers in predicting the outcome of treatment of newborns with EDC. The presence of a portion of the liver, stomach, and spleen in the thoracic cavity has no statistical significance in predicting the outcome of treatment of such children.