Prognostic markers in congenital diaphragmatic hernia: Left ventricular diameter and pulmonary hypertension

Karpuz, Derya; Giray, Dilek; Çelik, Yalçın; Hallioglu, Olgu

doi:10.1111/ped.13464

Cited by 10 publications

(10 citation statements)

References 19 publications

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“…This technique was utilized because it is both the most consistently reported method for defining CDH-PH and the most pragmatic method for collecting CDH-PH data from multiple international institutions [17][18][19]. While numerous other indices for assessing PH have been reported, their reproducibility is unknown [20][21][22]. And, other composite echocardiographic findings (septal location, ventricular size, pulmonary artery size, or patent ductus arteriosus flow patterns) could offer valuable information but are infrequently captured.…”

Section: Discussionmentioning

confidence: 99%

Early, Postnatal Pulmonary Hypertension Severity Predicts Inpatient Outcomes in Congenital Diaphragmatic Hernia

et al. 2021

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Introduction: Pulmonary hypertension (PH) is the major pathophysiologic consequence of congenital diaphragmatic hernia (CDH). We aimed to evaluate the association between early CDH-associated PH (CDH-PH) and inpatient outcomes. Methods: The CDH Study Group registry was queried for infants born 2015–2019 with echocardiograms before 48h of life. PH was categorized using echocardiographic findings: none, mild (right ventricular systolic pressure <2/3 systemic), moderate (between 2/3 systemic and systemic), or severe (supra-systemic). Univariate and multivariate analyses were performed. Adjusted Poisson regression was used to assess the primary composite outcome of mortality or oxygen support at 30 days. Results: Of 1,472 patients, 86.5% had CDH-PH: 13.9% mild (n = 193), 44.4% moderate (n = 631), and 33.2% severe (n = 468). On adjusted analysis, the primary outcome of mortality or oxygen support at 30 days occurred more frequently in infants with moderate (incidence rate ratio [IRR] 1.8, 95% confidence interval [CI], 1.2–2.6) and severe CDH-PH (IRR 2.0, 95% CI, 1.3–2.9). Extracorporeal life support (ECLS) utilization was associated only with severe CDH-PH after adjustment (IRR 1.8, 95% CI, 1.0–3.3). Discussion/Conclusion: Early, postnatal CDH-PH is independently associated with increased risk for mortality or oxygen support at 30 days and utilization of ECLS. Early echocardiogram is a valuable prognostic tool for early, inpatient outcomes in neonates with CDH.

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Section: Discussionmentioning

confidence: 99%

Early, Postnatal Pulmonary Hypertension Severity Predicts Inpatient Outcomes in Congenital Diaphragmatic Hernia

et al. 2021

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“…Additional relevant data were provided by one author [34]. Finally, 11 studies were included in this review (Table 1) [33,34,[36][37][38][39][40][41][42][43][44]. Fig.…”

Section: Search Resultsmentioning

confidence: 99%

“…There were signi cant variations in echocardiographic parameters among studies (Table 2). Two studies reported RV function [38,39], four reported LV function [33,34,37,43], and ve reported both RV and LV function [36,[40][41][42]44]. Two studies de ned LVD a priori [33,41].…”

Section: Prognostic Factorsmentioning

confidence: 99%

“…Nine studies reported the association of VF (any reported VF measurement) with survival [33,34,[36][37][38][39][40][41][42]. Four studies with 899 participants (range, 51-674), including 856 who survived, were pooled.…”

Section: Findings LV Function and Survivalmentioning

confidence: 99%

“…Of the 11 studies [33,34,[36][37][38][39][40][41][42][43][44], ten had a retrospective design, and one had a prospective cohort design. Among the multicenter studies, one was a registry-based international CDHSG collaboration [42].…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

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Ventricular Function in Congenital Diaphragmatic Hernia: A Systematic Review and Meta-Analysis

Prasad

Saha²,

Kumar

2021

Preprint

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There is emerging evidence supporting ventricular function as a prognostic factor in congenital diaphragmatic hernia (CDH). The present systematic review and meta-analysis aimed to determine the predictive value of early ventricular function for survival and extracorporeal membrane oxygenation (ECMO) requirement in newborns with CDH. PubMed, Google Scholar, Cochrane Central Register, Clinical Trial Registry, and Opengrey were accessed. Studies evaluating associations between echocardiographic ventricular function measured ≤ 48 h after birth and survival or ECMO requirement were included. Two independent authors extracted the following data: study and participant characteristics, prognostic factors, and outcome-related data. Eleven studies met the inclusion criteria. Five studies reported on survival, two on ECMO, and four on both outcomes. A moderate risk of bias was found in most of the studies, mainly because of selection, prognostic factors, and confounding biases. For survival (899 participants), pooled sensitivity and specificity were 86% (95% confidence interval [CI], 77–92%) and 44% (95% CI, 25–65%), respectively, in normal left ventricular function. For ECMO need (815 participants), pooled sensitivity and specificity were 39.8% (95% CI, 27–52%) and 88% (95% CI, 80–96%), respectively, in left ventricular dysfunction. Overall certainty of the evidence was graded very low for survival and low for ECMO. Inconsistent reporting of echocardiographic measurements and lack of adjustment for confounding factors were major limitations. Conclusions: Early ventricular dysfunction is a potential prognostic factor in CDH. Standardized echocardiographic measurement reporting and high-quality studies are needed to further elucidate its prognostic significance.

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The Utility of Serial Echocardiography Parameters in Management of Newborns with Congenital Diaphragmatic Hernia (CDH) and Predictors of Mortality

Soni

Chakkarapani

et al. 2022

Pediatr Cardiol

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Ventricular dysfunction may be found in 40% of newborns with CDH, and is not only a predictor of disease severity, but also mortality and need for ECMO. We conducted this study to assess the utility of serial echocardiography in management of newborns with CDH and their survival outcomes. This is a retrospective study, wherein the demographic, clinical and echocardiographic data from our local CDH registry and hospital clinical database were analyzed to study the correlation of timed echocardiographic findings with mortality and other outcomes. Fourty-two newborns with CDH were admitted during the study period (M/F:19/23), with median gestation of 38 weeks (IQR:36–39) and birth weight of 2.83 kg (IQR 2.45–3.17). Thirty-one were left-sided, seven right, one central, and three bilateral hernias. Twelve infants (28%) died in early infancy. Three infants were excluded from analysis due to either palliation at birth or significant cardiac anomaly. A total of 137 echos from 39 infants were analyzed. Seventy percent of newborns who died and had an echo within the first 72 h, were noted to have suffered from moderate to severe PH. Birth weight < 2.8 kg, RVSP > 45.5 in the first 72 h and postoperative VIS > 23.5 and RSS > 4.3 were good predictors of mortality. Markers of elevated pulmonary pressures and cardiac function were useful in guiding therapy. Serial timed functional echocardiography (f-Echo) monitoring allows targeted therapy of patients with CDH. Birth weight, initial severity of pulmonary hypertension and postoperative RSS and VIS may be useful in predicting mortality.

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Prognostic markers in congenital diaphragmatic hernia: Left ventricular diameter and pulmonary hypertension

Abstract: Decrease in LVEDD and presence of PH are associated with poor prognosis. Also, PH was associated with mortality in CDH patients. Thus, outcome may be predicted on careful echocardiographic evaluation of the LV diameters and pulmonary pressure.

Cited by 10 publications

References 19 publications

Early, Postnatal Pulmonary Hypertension Severity Predicts Inpatient Outcomes in Congenital Diaphragmatic Hernia

Early, Postnatal Pulmonary Hypertension Severity Predicts Inpatient Outcomes in Congenital Diaphragmatic Hernia

Ventricular Function in Congenital Diaphragmatic Hernia: A Systematic Review and Meta-Analysis

The Utility of Serial Echocardiography Parameters in Management of Newborns with Congenital Diaphragmatic Hernia (CDH) and Predictors of Mortality

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