Implementation of the Oxygen Saturation Index as a Predictor of Outcome in Prenatally Diagnosed CDH Neonates in the First 24 Hours of Life.

Abstract

This study aimed to evaluate the Oxygen Saturation Index (OSI) as a noninvasive measure for early postnatal management and outcome prediction in neonates with congenital diaphragmatic hernia (CDH). Additionally, the study analyzed the correlation and predictive ability of OSI, Oxygenation Index (OI), Horovitz Index (HI), and partial pressure of arterial oxygen (PaO2) regarding mortality and the need for extracorporeal membrane oxygenation (ECMO). A retrospective, single-center study using data from 2013 to 2020. Parameters for calculating indices were extracted from patient charts every hour during the first 24 h of life. Statistical analyses included ROC analysis for predictive cut-off values and Spearman's rank for correlation assessments. The study included 138 neonates. Postductal OSI demonstrated high sensitivity (80%-85%) and negative predictive value (NPV) for predicting mortality and ECMO need, with cut-off values between 11.5 and 13. Optimal cut-off values for predicting ECMO need were 10 at 12 and 24 h (sensitivity 96.7%). OSI, OI, HI, and PaO2 showed comparable predictive capabilities with strong correlations. The lowest OI of 18 predicted mortality with a sensitivity of 75% and specificity of 90.9%. Strong correlations were found between the lowest PaO2 and lowest HI (0.963-0.974), and between highest OI and lowest PaO2 (-0.922 to -0.945). OSI is a promising index for predicting outcomes in CDH neonates, showing strong correlation with indices like OI and HI. Despite limitations, OSI provides continuous, bedside monitoring without invasive blood sampling. Further prospective studies are needed to validate these findings and establish new cut-off values.