Fetal biophysical predictors of pulmonary hypertension severity, management, and treatment in infants born with congenital diaphragmatic hernia

Pulmonary hypertension (PHTN) causes significant morbidity and mortality in patients with congenital diaphragmatic hernia (CDH). Currently, there is no routinely obtained prenatal prognostic marker to reliably predict postnatal CDH-associated PHTN severity. The CDH Study Group (CDHSG) registry was q...

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Published inThe American journal of surgery Vol. 236; p. 115821
Main Authors Chase Binion, C., Agala, Chris B., Ebanks, Ashley H., Marzinsky, Amy, McLean, Sean E.
Format Journal Article
LanguageEnglish
Published New York Elsevier Inc 01.10.2024
Elsevier Limited
Subjects
Classification
Congenital diaphragmatic hernia
Diaphragm
Extracorporeal membrane oxygenation
Fetuses
Gestational age
Hernia
Hernias
Hypertension
Infants
Lung-to-head ratio
Lungs
Magnetic resonance imaging
Morbidity
Mortality
Pulmonary arteries
Pulmonary hypertension
Regression analysis
Ultrasonic imaging
Veins & arteries
Lung-to-head ratio
Congenital diaphragmatic hernia
Pulmonary hypertension
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Summary:Pulmonary hypertension (PHTN) causes significant morbidity and mortality in patients with congenital diaphragmatic hernia (CDH). Currently, there is no routinely obtained prenatal prognostic marker to reliably predict postnatal CDH-associated PHTN severity. The CDH Study Group (CDHSG) registry was queried for infants born from 2015 to 2021 with a graded (1–4) PHTN diagnosis. Fetal observed-to-expected lung volume to head circumference ratio (o/e LHR), percent predicted lung volume (PPLV), and total lung volume (TLV) were classified by severity. Of 4056 patients, 1047 and 785 infants had prenatal ultrasound or magnetic resonance imaging, respectively. Both moderate and severe o/e LHR were associated with increased odds of postnatal development of moderate (OR 2.913) and severe PHTN (OR 4.924). In infants with CDH, prenatal predictor severity was associated with higher severity of PHTN and increased ECLS usage. Overall, patients with worse prenatal prognostic indicators were less likely to receive pulmonary vasodilator treatment. •o/e LHR is a reliable prenatal predictor of PHTN severity, management, and treatment
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ISSN:0002-9610
1879-1883
1879-1883
DOI:10.1016/j.amjsurg.2024.115821