Neonatology
. 2021 Apr 13;1-8. doi: 10.1159/000512966. Online ahead of print. https://pubmed.ncbi.nlm.nih.gov/33849011/
Early, Postnatal Pulmonary Hypertension Severity Predicts Inpatient Outcomes in Congenital Diaphragmatic Hernia
Dalya Munves Ferguson 1 2, Vikas S Gupta 1 2, Pamela A Lally 1, Matias Luco 3, KuoJen Tsao 1 2, Kevin P Lally 1 2, Neil Patel 4, Matthew T Harting 1 2, Congenital Diaphragmatic Hernia Study GroupAffiliations expand
- PMID: 33849011
- DOI: 10.1159/000512966
Abstract
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.
Keywords: Congenital diaphragmatic hernia; Echocardiography; Mortality; Neonatal outcomes; Pulmonary hypertension.
© 2021 S. Karger AG, Basel.
