Link: https://www.ncbi.nlm.nih.gov/pubmed/30514095

Ann Clin Biochem. 2018 Dec 4:4563218820052. doi: 10.1177/0004563218820052. [Epub ahead of print]
ANNALS EXPRESS: Hematopoietic alterations in neonates with congenital diaphragmatic hernia receiving extracorporeal membrane oxygenation support.
Dolscheid-Pommerich R1, Kreuzer A2, Graeff I3, Stoffel-Wagner B4, Mueller A, Kipfmueller F5.
Author information
Abstract
Background Extracorporeal membrane oxygenation procedure (ECMO) has been established in the therapy of respiratory insufficient infants with congenital diaphragmatic hernia (CDH). In CDH newborns, a delay in transfer to an ECMO center is associated with a sharp increase in mortality. Predictive factors for ECMO support are urgently needed. We evaluated routine parameters of the first blood withdrawal after birth in CDH infants, hypothesizing that early signs in bone marrow affecting hematology parameters for early regulation of potentially post birth hypoxia are predictive factors for ECMO support. Materials and Methods In N=44 patients born with CDH, differential blood cell count from the first blood withdrawal after birth were examined. Descriptive statistics included median, 95% confidence intervals, minimum and maximum differentiating ECMO/early mortality vs. no ECMO. Odds ratios with CI were calculated by binary logistic regression analysis. Best predictive markers were further checked in combination with the liver-up situation in two factorial regression models. Results In our cohort, the survival rate was 77.3% (34/44). While 18 neonates received ECMO support, 26 experienced no ECMO during hospital stay. Odds ratio calculations showed that risk for ECMO support increases with augmenting leucocytes, erythrocytes, hemoglobin, hematocrit, MCV and absolute immature granulocytes. Further, the risk advanced in line with severity of CDH assessed by prenatal ultrasound. Conclusions We conclude that these parameters are associated with disease severity in CDH newborns and may be considered potentially predictive biomarkers for the necessity of ECMO support. Keywords Congenital diaphragmatic hernia, WBC, ECMO.

PMID: 30514095 DOI: 10.1177/0004563218820052