Congential Diaphragmatic Hernia

Question 1

What A-a gradient is predictive of non-survival in CDH?q

Answer 1

A-a > 500 mmHg when Fi02 =100%

Question 2

What A-a gradient is predictive of survival in CDH?

Answer 2

A-a gradient < 400 mmHg when FiO2 = 100%

Question 3

What is the most consistently effective therapeutic modality to achieve pulmonary vasodilation?

Answer 3

Respiratory Alkalosis

Question 4

What are contraindications to ECMO in a newborn?

Answer 4

1) EGA < 34 weeks
2) Weight < 2000 gm
3) Pre-existing grade II or greater intracranial hemorrhage
4) Congenital/neurologic abnormalities incompatible with good outcome
5) > 1 week off aggressive respiratory therapy
6) Congenital Heart Disease

Question 5

Entry criteria for ECMO on a newborn?

Answer 5

1) EGA > 40 weeks
2) Minimum weight 2000 gm
3) Predicted mortality > 80%
4) Reversible Process
5) Severe hyperemic, hypercarbic, palm HTN, unresponsive to max pharm/respiratory therapy

Question 6

How is predicted mortality estimated in newborn requiring ECMO?

Answer 6

Oxygenation index

Question 7

How is oxygenation index calculated?

Answer 7

FiO2 x mean airway pressure x 100/PaO2

Question 8

What oxygen index value predicts 80% mortality?

Answer 8

> 40