{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T16:31:42Z","timestamp":1779985902019,"version":"3.53.1"},"reference-count":21,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2016,10,25]],"date-time":"2016-10-25T00:00:00Z","timestamp":1477353600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100000272","name":"National Institute for Health Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004941","name":"Guy's and St Thomas' NHS Foundation Trust","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004941","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100009360","name":"King\u2019s College London","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100009360","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pediatric Anesthesia"],"published-print":{"date-parts":[[2016,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Mortality following surgical repair of congenital diaphragmatic hernia (<jats:styled-content style=\"fixed-case\">CDH<\/jats:styled-content>) remains high. The volume and type of perioperative intravenous fluid administered, baro\u2010trauma, oxygen toxicity, and the duration of anesthesia are thought to affect outcome in surgical populations<jats:bold>.<\/jats:bold><\/jats:p><\/jats:sec><jats:sec><jats:title>Aims<\/jats:title><jats:p>The aim of this retrospective observational study was to determine whether the perioperative volume or type of fluids and\/or the duration of anesthesia were associated with postoperative mortality and if mortality was predicted by the oxygenation index (<jats:styled-content style=\"fixed-case\">OI<\/jats:styled-content>) prior to or following <jats:styled-content style=\"fixed-case\">CDH<\/jats:styled-content> surgical repair.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The records of infants with a left\u2010sided <jats:styled-content style=\"fixed-case\">CDH<\/jats:styled-content> and without other congenital anomalies, who underwent surgical repair between April 2009 and March 2015, were examined. The oxygenation index was used to \u201cquantify\u201d the severity of lung function abnormality and reported as the best <jats:styled-content style=\"fixed-case\">OI<\/jats:styled-content> on day 1 after birth (<jats:styled-content style=\"fixed-case\">OI<jats:sub>BEST<\/jats:sub><\/jats:styled-content>), the <jats:styled-content style=\"fixed-case\">OI<\/jats:styled-content> immediately prior to surgery (<jats:styled-content style=\"fixed-case\">OI<jats:sub>PRE<\/jats:sub><\/jats:styled-content>) and at 1, 6, 12, and 24\u00a0h postsurgery (<jats:styled-content style=\"fixed-case\">OI<\/jats:styled-content><jats:sub>1h<\/jats:sub>, <jats:styled-content style=\"fixed-case\">OI<\/jats:styled-content><jats:sub>6h<\/jats:sub>, <jats:styled-content style=\"fixed-case\">OI<\/jats:styled-content><jats:sub>12h<\/jats:sub>, <jats:styled-content style=\"fixed-case\">OI<\/jats:styled-content><jats:sub>24h<\/jats:sub>), respectively. The change in the <jats:styled-content style=\"fixed-case\">OI<\/jats:styled-content> index (delta <jats:styled-content style=\"fixed-case\">OI<\/jats:styled-content>) was calculated by subtracting <jats:styled-content style=\"fixed-case\">OI<jats:sub>PRE<\/jats:sub><\/jats:styled-content> from postoperative <jats:styled-content style=\"fixed-case\">OI<\/jats:styled-content>s.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The records of 37 <jats:styled-content style=\"fixed-case\">CDH<\/jats:styled-content> infants (median gestational age 35.8, range 31.5\u201341.4\u00a0weeks) were assessed; six died postoperatively. Neither the duration of anesthesia, the volume of crystalloids or colloids administered, nor the peak inflation pressures used during surgical repair were significantly correlated with postoperative mortality. Neither fetal tracheal occlusion nor use of a parietal patch significantly influenced mortality. The postoperative <jats:styled-content style=\"fixed-case\">OI<\/jats:styled-content><jats:sub>1<\/jats:sub><jats:styled-content style=\"fixed-case\"><jats:sub>h<\/jats:sub><\/jats:styled-content>,<jats:styled-content style=\"fixed-case\"> OI<\/jats:styled-content><jats:sub>6h<\/jats:sub>, <jats:styled-content style=\"fixed-case\">OI<\/jats:styled-content><jats:sub>12h<\/jats:sub> showed weak evidence for a difference between survivors and nonsurvivors. An <jats:styled-content style=\"fixed-case\">OI<\/jats:styled-content><jats:sub>24h<\/jats:sub> of \u22655.5 predicted mortality with 100% sensitivity (95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>, confidence intervals (<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>) 40\u2013100) and 93.1% specificity (95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>, 77\u201399).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Neither the volume of intraoperative fluids administered nor the duration of anesthesia was associated with postoperative death. The <jats:styled-content style=\"fixed-case\">OI<\/jats:styled-content> 24\u00a0h postsurgery was the best predictor of an increased risk of mortality.<\/jats:p><\/jats:sec>","DOI":"10.1111\/pan.13008","type":"journal-article","created":{"date-parts":[[2016,10,25]],"date-time":"2016-10-25T12:06:41Z","timestamp":1477397201000},"page":"1197-1201","source":"Crossref","is-referenced-by-count":14,"title":["Mortality following congenital diaphragmatic hernia repair: the role of anesthesia"],"prefix":"10.1111","volume":"26","author":[{"given":"Chulananda","family":"Goonasekera","sequence":"first","affiliation":[{"name":"Department of Anaesthetics King's College Hospital NHS Foundation Trust London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kamal","family":"Ali","sequence":"additional","affiliation":[{"name":"Neonatal Intensive Care Centre King's College Hospital NHS Foundation Trust London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ann","family":"Hickey","sequence":"additional","affiliation":[{"name":"Neonatal Intensive Care Centre King's College Hospital NHS Foundation Trust London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lekshmi","family":"Sasidharan","sequence":"additional","affiliation":[{"name":"Neonatal Intensive Care Centre King's College Hospital NHS Foundation Trust London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Malcolm","family":"Mathew","sequence":"additional","affiliation":[{"name":"Department of Anaesthetics King's College Hospital NHS Foundation Trust London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Davenport","sequence":"additional","affiliation":[{"name":"Department of Paediatric Surgery Kings College Hospital NHS Foundation Trust London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne","family":"Greenough","sequence":"additional","affiliation":[{"name":"Division of Asthma, Allergy and Lung Biology MRC Centre for Allergic Mechanisms of Asthma King's College London London UK"},{"name":"NIHR Biomedical Centre at Guy's &amp; 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