Early Postnatal Ventricular Disproportion Predicts Outcome in Congenital Diaphragmatic Hernia

Pugnaloni, Flaminia; Bo, Bartolomeo; Hale, Lauren; Capolupo, Irma; Dotta, Andrea; Bagolan, P; Schroeder, Lukas; Berg, Christoph; Geipel, A.; Müller, Andreas; Patel, Neil; Kipfmueller, Florian

doi:10.1164/rccm.202212-2306le

Cited by 10 publications

(6 citation statements)

References 10 publications

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“…29 Additionally, LV afterload is affected by a reduced pleural pressure as observed during positive pressure ventilation and a higher RV pressure might worsen LV filling by shifting the intraventricular septum toward the LV. 30 Although PCO 2 was significantly higher in the SBA group, this did not result in relevant acidosis.…”

Section: Discussionmentioning

confidence: 81%

“…Furthermore, the application of an inadequate PEEP during mechanical ventilation can cause alveolar overdistension which is associated with an increased PVR, leading to a higher PAP and a reduced pulmonary venous return 29 . Additionally, LV afterload is affected by a reduced pleural pressure as observed during positive pressure ventilation and a higher RV pressure might worsen LV filling by shifting the intraventricular septum toward the LV 30 . Although PCO 2 was significantly higher in the SBA group, this did not result in relevant acidosis.…”

Section: Discussionmentioning

confidence: 99%

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Spontaneous breathing in selected neonates with very mild congenital diaphragmatic hernia

Kipfmueller,

Leyens,

Pugnaloni

et al. 2023

Pediatric Pulmonology

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AimsCurrent treatment guidelines recommend immediate postnatal intubation in all neonates with congenital diaphragmatic hernia (CDH). This study aimed to investigate the feasibility and outcomes of a spontaneous breathing approach (SBA) versus immediate intubation in neonates with prenatally diagnosed very mild CDH.MethodsA retrospective study was conducted comparing neonates with very mild CDH (left‐sided, liver‐down, observed‐to‐expected lung‐to‐head ratio ≥45%) undergoing SBA and matched controls receiving standard treatment. Data on early echocardiographic findings, respiratory support, length of hospital stay, and clinical outcomes were analyzed.ResultsOf 151 CDH neonates, eight underwent SBA, while 31 received standard treatment. SBA was successful in six of eight patients. SBA patients had shorter length of stay (14 vs. 30 days, p = .005), mechanical ventilation (3.5 vs. 8.7 days, p = .011), and oxygen supplementation (3.2 vs. 9.3 days, p = .013) compared to matched controls. Echocardiographic evidence of pulmonary hypertension and cardiac dysfunction were significantly lower in SBA neonates after admission but similar before surgical repair. The SBA group tolerated enteral feeding earlier (day of life 7 vs. 16, p = .019).ConclusionsSBA appears feasible and beneficial for prenatally diagnosed very mild CDH. It was associated with a shortened hospital stay supportive therapies. However, larger trials are needed to confirm these findings and determine optimal respiratory support.

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Section: Discussionmentioning

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Spontaneous breathing in selected neonates with very mild congenital diaphragmatic hernia

Kipfmueller,

Leyens,

Pugnaloni

et al. 2023

Pediatric Pulmonology

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“…In clinical scenarios involving persistent pulmonary hypertension, POCUS aids in estimating pulmonary artery systolic pressure, assessing shunt direction, and evaluating ventricular size, symmetry, septal position, and function, thereby elucidating information on diastolic and systolic pressures. Moreover, parameters such as the pulmonary arterial acceleration time (PAAT) to right ventricular ejection time (RVET) ratio offer valuable insights into pulmonary vascular resistance [ 2 , 18 , 19 , 78 , 79 ]. In this setting, POCUS assessment facilitates the differentiation between pre- and postcapillary pulmonary hypertension and the recognition of cardiopulmonary interactions, which enables physicians to tailor individualized pathophysiology-based treatment strategies [ 80 , 81 ].…”

Section: Resultsmentioning

confidence: 99%

“…In assessments of lung development and congenital abnormalities, POCUS aids in predicting bronchopulmonary dysplasia, diagnosing conditions like congenital diaphragmatic hernia and chylothorax, and in monitoring the response to surfactant therapy in neonates [ 2 , 17 , 18 , 35 ]. Assessing ductus arteriosus flow, early postnatal ventricular disproportion, and pulmonary hypertension—indicated by an index of approximately 0.3, calculated from the pulmonary artery acceleration time to the right ventricular ejection time—represent feasible parameters for predicting outcomes in neonates with congenital diaphragmatic hernia [ 78 , 79 , 82 ]. Furthermore, diaphragmatic motion assessment using M-mode allows for quantitative evaluation of diaphragmatic excursion, with 0.5 to 1 cm serving as an acceptable range, providing valuable insights into respiratory function.…”

Section: Resultsmentioning

confidence: 99%

Applications of Point-of-Care-Ultrasound in Neonatology: A Systematic Review of the Literature

Recker,

Kipfmueller,

Wittek

et al. 2024

Life

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Point-of-care ultrasound (POCUS) integration into neonatology offers transformative potential for diagnostics and treatment, enhancing immediacy and precision of clinical decision-making in this vulnerable patient population. This systematic review aims to synthesize evidence on POCUS applications, benefits, challenges, and educational strategies in neonatology. Literature search was conducted using SPIDER scheme keywords and MeSH terms related to POCUS and neonatology. Studies focusing on POCUS applications, its impact on clinical outcomes, and educational interventions for skill acquisition were included and analyzed using standardized tools, followed by a narrative synthesis of the findings. The search yielded 68 relevant publications, encompassing original research, reviews, and guidelines. POCUS applications varied across cardiovascular, pulmonary, neurological, and abdominal assessments. Key benefits included a reduced need for invasive procedures and rapid bedside diagnosis. Challenges included steep learning curves for clinicians and the need for standardized training and guidelines. Educational strategies highlighted the effectiveness of simulation-based training in enhancing ultrasound proficiency among neonatal care providers. POCUS represents a significant advancement in neonatal medicine, offering benefits for patient care. Addressing identified challenges through comprehensive training programs and developing standardized guidelines is crucial for optimized use. Future research should focus on evaluating educational outcomes and long-term impacts of POCUS integration into neonatal care.

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“…42 Postnatal phenotypes observed in neonates with CDH range from normal ventricular size and function to impaired RV function with dilated RV, to a small, dysfunctional LV. 43 The clinical presentation of CDH may vary significantly during the early postnatal phase of hospitalization, through the perioperative period-distinguished by either improvement or worsening of PHT-and into the late postoperative phase, which in severe cases may be characterized by chronic PHT. The introduction, discontinuation, and precise modulation of therapeutic interventions must occur within the framework of a tailored hemodynamic management strategy, based on an on-demand, real-time assessment of hemodynamic status.…”

Section: Role Of Echocardiography Initial Screening and Diagnostic As...mentioning

confidence: 99%

Hemodynamic management of congenital diaphragmatic hernia: the role of targeted neonatal echocardiography

Surak,

Mahgoub,

Ting

2024

World Jnl Ped Surgery

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Congenital diaphragmatic hernia (CDH) is a major congenital anomaly, resulting from the herniation of abdominal contents into the thoracic cavity, thereby impeding the proper development of the lungs and pulmonary vasculature. CDH severity correlates with a spectrum of pulmonary hypoplasia, pulmonary hypertension (PHT), and cardiac dysfunction, constituting the pathophysiological triad of this complex condition. The accurate diagnosis and effective management of PHT and cardiac dysfunction is pivotal to optimizing patient outcomes. Targeted neonatal echocardiography is instrumental in delivering real-time data crucial for the bespoke, pathophysiology-targeted hemodynamic management of CDH-associated PHT.

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Early Postnatal Ventricular Disproportion Predicts Outcome in Congenital Diaphragmatic Hernia

Cited by 10 publications

References 10 publications

Spontaneous breathing in selected neonates with very mild congenital diaphragmatic hernia

Spontaneous breathing in selected neonates with very mild congenital diaphragmatic hernia

Applications of Point-of-Care-Ultrasound in Neonatology: A Systematic Review of the Literature

Hemodynamic management of congenital diaphragmatic hernia: the role of targeted neonatal echocardiography

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