Grizelj, Ruža

Objective Reference values of regional cerebral oxygen saturation (rScO 2 ) in preterm neonates across gestational age (GA) groups remain undefined. This study aimed to establish rScO 2 references for neonates born before 32 weeks of gestation. Design A prospective observational cohort study. Setting Large tertiary neonatal referral centre in Croatia. Patients Preterm neonates without major comorbidities born between 2018 and 2022 with normal cranial ultrasound findings. Interventions rScO 2 was assessed with near-infrared spectroscopy (NIRS) using neonatal sensors. Main outcome measures The primary analysis provided rScO 2 reference ranges for the entire preterm neonatal cohort, followed by stratified analyses based on GA: extremely preterm , <28.0 weeks; very preterm , 28.0–30.0 weeks; and very preterm , 30.1–32.0 weeks. Quantile regression was used to estimate the selected rScO 2 percentiles (5th, 10th, 50th, 90th and 95th) from 6 to 72 hours after birth. Results 114 neonates with median (IQR) GA of 29.9 (29.1–31.5) weeks were included: 22% were EP <28w , 29% were VP 28–30w and 49% were VP >30–32w . The median rScO 2 was 75.6% at 6 hours, 79.5% over the first 24 hours and exceeding 80% in the subsequent 48 hours. When analysed separately, notable differences emerged across prematurity categories, with the highest median rScO 2 observed in the VP >30–32w group. Supplementary analyses, comparing rScO 2 values across the three GA groups, revealed significant differences at 48 and 72 hours. The majority of the estimated rScO 2 fifth percentiles between 6 and 72 hours were in the range ≥60%, with a single lowest estimate of 56.3% at 6 hours in the EP <28w group. Thus, for all subgroups, the estimated fifth percentile of rScO 2 was above the brain hypoxic threshold. Conclusions The use of age-appropriate neonatal NIRS sensors provided the rScO 2 reference values for very and extremely preterm neonates without major comorbidities 6–72 hours after birth.

Background Congenital diaphragmatic hernia (CDH) has different clinical presentations depending on whether it is right sided (R-CDH) or left sided (L-CDH). Some have suggested that L-CDH and R-CDH may represent different syndromic phenotypes. This theory would be indirectly supported if different nondiaphragmatic anomalies were associated with laterality. We assessed whether CDH laterality is associated with specific types of nondiaphragmatic anomalies. Methods Cases of CDH were retrospectively identified from five centers, and associated congenital anomalies, prenatal diagnosis, demographics, birth characteristics, and side of the CDH were analyzed. CDH characteristics were summarized according to the absence (isolated) or presence (complex) of nondiaphragmatic malformations. Results Among 228 neonates with CDH, 140 (61%) had isolated CDH and 88 (39%) had complex CDH. Complex CDH was significantly associated with being small for gestational age (odds ratio [95% confidence interval, CI]: 8.3 [1.9–35.7]; p = 0.005) and having L-CDH (odds ratio [95% CI]: 3.6 [1.5–8.9]; p = 0.005). The overall proportion with anomalies differed by side (42% for L-CDH, 23% for R-CDH; p = 0.02), but the rates of anomalies in specific organ systems did not differ. Conclusion The rate of associated nondiaphragmatic anomalies by specific organ system did not differ between L-CDH and R-CDH, which suggests that they represent the same phenotypic entity.

SummaryBackgroundCongenital diaphragmatic hernia (CDH) is a rare anomaly with high mortality and long‐term comorbid conditions.AimsOur aim was to describe the presenting characteristics, treatment, and outcomes of consecutive patients with CDH treated at our institution.MethodsWe performed a retrospective cohort study and identified consecutive neonates treated for CDH from 2001 to 2015 at our institution. For all patients identified, we reviewed hospital and postdischarge data for neonatal, disease, and treatment characteristics. We determined hospital survival overall and also according to the presence of prenatal diagnosis, liver herniation into the chest (liver up), and the use of extracorporeal membrane oxygenation (ECMO) in addition to surgery. We evaluated postdischarge chronic conditions in patients with at least one year of follow‐up.ResultsThirty‐eight neonates were admitted for treatment during the study period. In three who were in extremis, life support was withdrawn. The other 35 underwent surgical repair, of whom eight received ECMO. The overall survival was 79% (30/38). Survival for those who had surgical correction of CDH but did not need ECMO was 89% (24/27); it was 75% (6/8) for those who received ECMO and had surgery. Hospital survival was lower for liver‐up vs liver‐down CDH (61% [11/18] vs 95% [19/20]; odds ratio, 0.08; 95% CI, 0.01–0.77; P = 0.01). Among survivors, the median duration of hospitalization was 31 (interquartile range, 20–73) days. Major chronic pulmonary and gastrointestinal disorders, failure to thrive, and neurodevelopmental delays were the most noted comorbid conditions after discharge, and all were more prevalent in those who required ECMO.ConclusionThe overall survival of neonates with CDH was 79%. Intrathoracic liver herniation was associated with more frequent use of ECMO and greater mortality. A substantial number of survivors, especially those who required ECMO, experienced chronic conditions after discharge.

AbstractBackgroundOutcomes of neonates with congenital diaphragmatic hernia (CDH) are variable; reports are frequently limited to the experience of single tertiary care centres—a possible source of bias. Population‐based studies decrease survivor bias and provide additional insight into this high‐mortality condition. The objective of this study was to examine the incidence and outcomes of CDH in Croatia.MethodsAll cases of CDH in Croatia from 2001 through 2013 were ascertained from public health records. Overall and sex‐ and region‐specific incidence rates were calculated, and characteristics associated with 1‐year survival were assessed.ResultsWe identified 145 cases of CDH during the study period, for an incidence of 2.67 per 10 000 total births. The incidence did not differ by calendar year (P = 0.38) or geographic region (P = 0.67). There was a slightly higher incidence among males (rate ratio, 1.37, 95% CI 0.99, 1.91). The 1‐year survival rate was 33.1% for the entire cohort and 47.9% for liveborns who received any treatment at an intensive care unit. From multivariable analysis, survival was decreased in neonates with left CDH, liver up (odds ratio 0.1, 95% CI, 0.03, 0.4) and increased when treated in a centre with higher case volume (odds ratio 12.8, 95% CI, 2.2, 72.1).ConclusionsThe incidence of CDH in Croatia is within the range of previous reports. Survival was substantially higher in neonates treated in a centre with higher case volume, which suggests that centralisation of medical care for CDH may be warranted in Croatia.