Abstract
INTRODUCTION: The aim of this study was to correlate oxygenation index (OI) and oxygen saturation index (OSI) in congenital diaphragmatic hernia (CDH) and determine the impact of guideline changes from two different epochs. METHODS: Retrospective analysis of 390 CDH neonates managed at University of Utah/Primary Children's Hospitals from 2003 to 2024. We performed regression analysis for paired OI and OSI values over the first week of life (2,604 pairs), comparing pre- (2003-2015) and post- (2016-2024) epoch effects of a 2016 CDH guideline. We analyzed predictive abilities for OI and OSI within and between epochs for extracorporeal membrane oxygenation (ECMO) and/or death. RESULTS: OI and OSI showed higher correlation in the post- (R2 = 0.755) vs. pre-epoch (R2 = 0.650). Between epochs analysis demonstrated lower inspired oxygen, mean airway pressure, arterial oxygen pressure, OI, and OSI in the post-epoch. ECMO use was lower in post-epoch (9.8% vs. 33%), but pre-ECMO OI and OSI were similar between epochs. Classification of severe lung dysfunction by OI >25 or OSI >12 showed similar abilities to predict ECMO and/or death. DISCUSSION: OI and OSI were highly correlated in CDH but affected by variation in CDH management. OSI classified severity of cardiopulmonary dysfunction as effectively as OI.