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

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.

Prevalence of pericardial effusions in children with large atrial or ventricular septal defect.

Recently, a high percentage of adults with isolated secundum atrial septal defects (ASD) and ventricular septal defects (VSD) undergoing surgical repair had a circumferential pericardial effusion (PE), preoperatively. It was our impression that PEs are uncommon in children with unrepaired ASD or VSD. To evaluate this impression, we performed a retrospective study to determine the prevalence of PE in children with ASD compared with those with VSD and with children with normal cardiac anatomy. The preoperative echocardiograms of 90 patients with isolated surgical grade secundum ASDs, 75 patients with isolated VSDs, and 91 normal patients were reviewed to evaluate for the presence or absence of pericardial effusions and also the septal defect size. Only 1 patient (ASD group) of the total 256 had a global PE (0.4%). No large effusions were found in any group. Eighty-one children (32%) had any effusion present in the pericardial space. The prevalence of these small PEs was not significantly different between the ASD (36/90, 40%) and VSD (23/75, 31%, p=0.25) groups. The patients with ASD, however, had a significantly higher prevalence of PEs compared with the control group (22/91, 24%, p<0.03). In conclusion, the presence of global PEs in children with surgical grade ASD or patients with VSD is rare, unlike that reported in adults with the same lesions. Trace effusions are found more commonly in children with ASD than those in VSD or in normal children, which may herald a potential for larger effusions with a longer time before defect closure.