The ability to predict survival in critically ill newborns would have obvious beneficial implications. Based on this premise, Hageman and coworkers1 retrospectively analyzed several factors to determine survival in infants with pulmonary hypertension (PPHN). In brief, the highest alveolararterial oxygen gradient (A-aDO2) at or near diagnosis was found to be a good predictor of nonsurvival. Specifically, nonsurvivors had significantly higher A-aDO2 values than survivors (mean, 618 vs 521 mm Hg). Additionally, 92% of nonsurvivors had gradients of 600 mm Hg or greater compared with 37% of survivors. Air leak was also more frequent in nonsurvivors. Interestingly, survivors had an increased percentage of right-to-left shunting at the ductal level compared with nonsurvivors. The authors did not postulate a mechanism for this interesting but perplexing finding.
Hageman and colleagues' study is a laudatory effort at determining predictors of nonsurvival in a select group of patients. However, clarification of several elements
GERALD MARX. Prediction of Nonsurvival in Critically Ill Infants With Respiratory FailureWhich Patients Are Candidates for Extracorporeal Membrane Oxygenation?. Am J Dis Child. 1988;142(3):261–262. doi:10.1001/archpedi.1988.02150030027013