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. 2025 Dec 22:1-9.
doi: 10.1159/000550139. Online ahead of print.

Oxygenation Index and Oxygen Saturation Index in Congenital Diaphragmatic Hernia: Do Management Guidelines Make a Difference?

Tanner S Ellsworth  1 , Ryan J Carpenter  1   2 , Christian C Yost  1   3 , Bradley A Yoder  1 , Michelle J Yang  4
Affiliations

Oxygenation Index and Oxygen Saturation Index in Congenital Diaphragmatic Hernia: Do Management Guidelines Make a Difference?

Tanner S Ellsworth et al. Neonatology. .

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.

Keywords: Congenital diaphragmatic hernia; Extracorporeal membrane oxygenation; Outcome prediction; Oxygen saturation index; Oxygenation index.

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Conflict of interest statement

The authors listed certify that they have no affiliations with or involvement in any organization or entity with any financial or nonfinancial interest in the subject matter or materials discussed in this manuscript.

Figures

Fig. 1.
Fig. 1.
Linear regression curve analysis and equations for OI and OSI correlation in two epochs with different management guidelines for neonatal diaphragmatic hernia. Oxygenation index (OI; [FiO2 × Paw]/PaO2) is on the x-axis and oxygen saturation index (OSI; [FiO2 × Paw]/SpO2) is on the y-axis. Epoch 1 (2003–2015) was characterized by early transfer, higher FiO2 and Paw, and more vasoactive interventions with increased ECMO and death rates. Epoch 2 (2016–2024) was characterized by delayed transfer, lower Paw and FiO2, and less vasoactive interventions with decreased ECMO and death rates. Linear correlation is higher in epoch 2, with lower constant in the equation. FiO2, fraction inspired oxygen; Paw, mean airway pressure; PaO2, partial pressure arterial oxygen; SpO2, peripheral oxygen saturation; ECMO, extracorporeal membrane oxygenation.
Fig. 2.
Fig. 2.
Epoch classification of lung dysfunction by oxygenation index (OI, black bars) and oxygen saturation index (OSI, gray bars). A significant difference was found between epochs (solid bars: 2003–2015; diagonal bars: 2016–2024) for classification of mild and severe lung dysfunction by OI and OSI (*p < 0.05). There was a significant difference between OI and OSI within the 2003–2015 epoch for classification of mild or severe lung dysfunction (#p < 0.05). OI and OSI showed similar classification rates for mild, moderate, and severe lung dysfunction in the 2016–2024 epoch.
See this image and copyright information in PMC

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