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

• Published in: The American journal of surgery 2024-10, Vol.236, p.115821, Article 115821
• Main Authors: Chase Binion, C., Agala, Chris B., Ebanks, Ashley H., Marzinsky, Amy, McLean, Sean E.
• Format: Article
• Language: English
• Subjects: Classification; Congenital diaphragmatic hernia; Diaphragm; Extracorporeal Membrane Oxygenation; Female; Fetuses; Gestational age; Hernia; Hernias; Hernias, Diaphragmatic, Congenital - complications; Hernias, Diaphragmatic, Congenital - diagnosis; Hernias, Diaphragmatic, Congenital - diagnostic imaging; Hernias, Diaphragmatic, Congenital - mortality; Hernias, Diaphragmatic, Congenital - therapy; Humans; Hypertension; Hypertension, Pulmonary - diagnosis; Hypertension, Pulmonary - etiology; Infant, Newborn; Infants; Lung-to-head ratio; Lungs; Magnetic Resonance Imaging; Male; Morbidity; Mortality; Pregnancy; Prognosis; Pulmonary arteries; Pulmonary hypertension; Registries; Regression analysis; Retrospective Studies; Severity of Illness Index; Ultrasonic imaging; Ultrasonography, Prenatal; Veins & arteries
• ISSN: 0002-9610; 1879-1883; 1879-1883
• DOI: 10.1016/j.amjsurg.2024.115821

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