Echocardiography derived pulmonary artery capacitance and right ventricular outflow velocity time integral on first day of life can predict survival in congenital diaphragmatic hernia☆
Section snippets
Abbreviations used
CDH congenital diaphragmatic hernia PAC pulmonary artery capacitance PVR pulmonary vascular resistance RVOT VTI right ventricular outflow velocity time integral AT acceleration time RVET right ventricular ejection time
Methods
After institutional review board approval, we reviewed the records of 28 consecutive congenital diaphragmatic hernia patients treated at our institution from January 2008 through December 2015. Inclusion criteria included: all congenital diaphragmatic hernia patients admitted to Virginia Commonwealth University neonatal intensive care unit. Exclusion criteria were: genetic syndrome (e.g. Down syndrome), hereditary malformation of upper or lower air way disease, pulmonary vein stenosis, aorto
Results
We reviewed all 28 CDH infants presenting over the 7-year period. Eight infants were excluded due to meconium aspiration (n = 2), perinatal hypoxia (n = 2), positive for group B streptococci (n = 20, hypothermia (n = 1) and inadequate echo data (n = 1). The remaining 20 patients represent the study group.
Frequency of liver herniation (p = 0.02), ECMO duration (p = 0.003) and type of repair (p = 0.0001) differentiated survivors from non-survivors in CDH patients. While, gestational age (p = 0.05), gender (p = 0.6),
Discussion
Congenital diaphragmatic hernia is a condition with a highly variable outcome despite many advances in care. Identifying high-risk infants prenatally as well as postnatally may allow for targeted therapy [15] and help physicians reduce resource use by directing expensive treatment (ECMO) towards patients who may best benefit from it [16].
We found three non-echo parameters that can differentiate survivors versus non-survivors: liver herniation, ECMO duration and type of diaphragmatic hernia
Conclusion
Pulmonary artery capacitance and RVOT velocity time integral measured in first 24 h of life can predict survivors versus non-survivors CDH infants. Furthermore, these echocardiographic parameters can be obtained in every patient regardless of the severity of TR. Pulmonary artery capacitance and RV velocity time integral may better detect the total RV-pulmonary vascular interaction in CDH patients and may be helpful to direct the clinical management of these patients and perhaps others.
Recommendation
Larger prospective studies are needed that incorporate pulmonary artery capacitance and RVOT velocity time integral in each echo study for CDH infants to validate or reject our results. Our results may help in parents counseling and ECMO support patient selection.
Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not –for-profit services.
Acknowledgment
We thank Dr. Zack Goode at Virginia Commonwealth University for assistance with methodology that greatly improved the manuscript.
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Authors declare there is no conflict of interest.