Early postnatal echocardiographic assessment of pulmonary blood flow in newborns with congenital diaphragmatic hernia

Abstract

Objective: Echocardiography is the most important tool to assess infants with congenital diaphragmatic hernia (CDH) for pulmonary hypertension (PH). The pattern of blood flow in the pulmonary artery [described as time to peak velocity (TPV)/right ventricular ejection time (RVET) ratio] provides distinct information about pulmonary arterial pressure. The aim of our study was to investigate the correlation of TPV/RVET measurements with the most commonly used classification system for PH in CDH newborns and the association of these measurements with outcome parameters. Methods: Echocardiographic measurements were obtained in 40 CDH newborns within 6 h of life. The obtained measurements were correlated with the decision for or against extracorporeal membrane oxygenation (ECMO); early mortality; total duration of mechanical ventilation and total duration of oxygen supplementation. Results: The correlation coefficient between severity of PH and TPV/RVET measurements was −0.696 (P<0.001). Using receiver operating characteristic (ROC) analyses the optimal cutoff for TPV/RVET in order to predict the necessity for ECMO or early mortality without ECMO was 0.29 with a sensitivity of 86.7%, a specificity of 68%, a positive predictive value of 61.9% and a negative predictive value of 89.5%. Newborns with a TPV/RVET below the cutoff had a 5.9-fold risk for ECMO or early mortality, a significantly longer duration of mechanical ventilation (13.4 days vs. 7.4 days, P=0.003) and oxygen supplementation (22.4 days vs. 9.0 days, P=0.019), and a lower survival rate (76.2% vs. 100%, P=0.021). Conclusions: TPV/RVET is a feasible parameter to assess PH in CDH newborns with close correlation to outcome parameters.

Expression of soluble receptor for advanced glycation end products is associated with disease severity in congenital diaphragmatic hernia

“…Pulmonary hypertension (PH) and lung hypoplasia are major contributors to morbidity and mortality in these infants (9). Early risk stratification is important to assess the patient for specific therapies to improve hemodynamics and oxygenation [e.g., by pulmonary vasodilators, extracorporeal membrane oxygenation (ECMO)] (14,23). Risk stratification beyond the first week of life could aim to identify infants at risk for long-term comorbidities, such as long-term oxygen dependency or relevant PH (17).…”

“…Therefore, the OI might fail as an early parameter in a certain amount of CDH newborns. Another important tool for risk stratification is echocardiographic assessment of PH and cardiac dysfunction, both valuable techniques in experienced observers but not without limitation (14,25).…”

Prediction of ECMO and Mortality in Neonates with Congenital Diaphragmatic Hernia Using the SNAP-II Score

“…However, these measurements require prenatal assessment which may not be available in all patients. Several attempts for postnatal risk stratification have been introduced including blood biomarkers, clinical risk scores, echocardiographic assessment and physiological parameters [10,12,14,15,17,23].…”

“…Pulmonary hypertension (PH) and lung hypoplasia are major contributors to morbidity and mortality in CDH newborns [5]. Early risk stratification is important to assess patients for specific therapies to improve hemodynamics and oxygenation (e. g. pulmonary vasodilators, extracorporeal membrane oxygenation (ECMO)) [10].…”

Hidrocefalia De Pressão Normal: Desafios Diagnósticos E Conduta

“…As hérnias diafragmáticas congênitas (HDC) são caracterizadas por um defeito embriológico do diafragma que resulta na migração das vísceras abdominais para o interior da cavidade torácica (KALANJ et al, 2016). A incidência varia de 1:2.500 a 1:4.000 nascidos vivos, que tradicionalmente apresentam alta mortalidade devido ao grave comprometimento respiratório e cardiovascular (KALANJ et al, 2016;KIPFMUELLER et al, 2018;LALLY, 2016;FUMINO et al, 2005 Wung (2004), atualmente a estabilização pré-operatória é mandatória por aumentar a complacência pulmonar e diminuir a resistência vascular.…”