Impact of target blood gases on outcome in congenital diaphragmatic hernia (CDH).

INTRODUCTION: Neonatal intensive care unit (NICU) stabilization strategies which normalize physiology according to predetermined blood gas targets may contribute to observed improved survival rates of patients with CDH. The purpose of our study was to compare risk-adjusted outcomes of CDH patients managed with or without blood gas targets established at NICU admission. METHODS: Cases were collected from a national CDH network between May 2005 and November 2007. On NICU admission, the responsible neonatologist was asked to establish target ranges for pH, pCO (2), pO (2), and pre/post-ductal O (2) saturation. The outcomes analyzed were mortality, need for ECMO, days of mechanical ventilation/supplemental oxygen, and length of stay. RESULTS: Of 147 CDH infants, 63 had admission blood gas targets. Severity of illness and gestational age in both groups were comparable (SNAP-II score). Infants with blood gas targets had a significantly lower mortality than those without (Hazard ratio 0.27, p=0.006). CONCLUSIONS: Blood gas targets for the management of infants with CDH are associated with improved survival. Although the willingness to create and use stabilization targets to guide early NICU care may be a surrogate for other factors (experience, staffing, lack of interest), it is clearly associated with improved survival in CDH.

Higher serum C-reactive protein predicts short and long-term outcomes in peritoneal dialysis-associated peritonitis.

We examined the association between C-reactive protein (CRP) and short- and long-term adverse outcomes in peritoneal dialysis (PD)-associated peritonitis. Serum CRP levels were measured at baseline and 3 weeks after initiation of treatment in 209 patients with an incident episode of peritonitis between 1 January 1999 and 31 March 2005. Patients were followed until 31 May 2005. Short-term adverse outcomes included switch to hemodialysis, death, persistent infection beyond planned therapy duration, and relapse; long-term adverse outcomes included a subsequent peritonitis event or death. After adjustment for age, gender, diabetes, duration of renal replacement therapy and causative organism, patients with higher CRP levels at diagnosis had a greater odds of an adverse short-term outcome (odds ratio 1.57 (95% confidence interval (CI): 0.61-4.02), 2.73 (95% CI: 1.09-6.87), and 3.38 (95% CI: 1.36-8.42) in the second, third, and highest quartiles). In patients who met criteria for resolution of peritonitis 3 weeks after diagnosis, those with higher CRP levels had a greater risk of a long-term adverse outcome (hazard ratio 1.79 (95% CI: 1.05-3.07)). In conclusion, higher levels of CRP are independently associated with adverse outcomes in PD-associated peritonitis. Serial measurement of this marker during the course of peritonitis may facilitate earlier identification of individuals at greater risk of complications.