Objective To compare the left ventricular Eccentricity Index (EI) and tricuspid valve systolic:diastolic (SD) ratio in infants at risk of bronchopulmonary dysplasia (BPD) and pulmonary hypertension (PH). Study Design Review of echocardiograms performed on infants born at ≤28 weeks postmenstrual age, categorized into three cohorts: BPD and PH (n=13); BPD only (n=16); and controls (n=59). EI was measured from a parasternal short axis 2D image. The SD ratio was measured from the continuous wave Doppler tracing. Groups were compared using Kruskal-Wallis and Wilcoxon rank sum tests. Result EI and SD ratio were successfully measured in all infants. There were no differences between controls and BPD cohort. In contrast, the BPD and PH cohort had increased systolic EI (1.46 vs 1.00–1.01), diastolic EI (1.47 vs 1.00), and SD ratio (1.12 vs 0.97–1.00) compared to controls and BPD only cohort (P≤0.01 for all). Conclusion The EI and SD ratio may be useful as a screening tool for PH in this population.

TAPSE, GLPS, and right-to-left PDA shunting were associated with progression to death/ECMO. RV free wall strain was not associated with the outcome, suggesting that diminished global strain better reflects clinical outcomes in this group. These thresholds may assist in the decision-making to transfer high-risk infants to ECMO centres.

Objective Congenital diaphragmatic hernia (CDH) is fatal in 20–40% of cases, largely due to pulmonary dysmaturity, lung hypoplasia, and persistent pulmonary hypertension. Evidence for survival benefit of inhaled nitric oxide (iNO), extracorporeal membrane oxygenation (ECMO), and other medical interventions targeting pulmonary hypertension is lacking. We assessed medical interventions and mortality over time in a large multicenter cohort of infants with CDH. Study Design We identified all infants ≥34 weeks gestation with CDH discharged from 29 neonatal intensive care units between 1999 and 2012 with an average of ≥2 CDH admissions per year. We examined mortality and the proportion of infants exposed to medical interventions, comparing 4 periods of time: 1999–2001, 2002–2004, 2005–2007, and 2008–2012. Results We identified 760 infants with CDH. From 1999–2001 to 2008–2012, use of iNO increased from 20% of infants to 50%, sildenafil use increased from 0% to 14%, and milrinone use increased from 0% to 22% (p<0.001). Overall mortality (28%) did not significantly change over time compared with the earliest time period. Conclusions Despite changing use of iNO, sildenafil, and milrinone, CDH mortality has not significantly decreased in this population of infants.