Ductus arteriosus flow predicts outcome in neonates with congenital diaphragmatic hernia

• DOI: 10.1002/ppul.26385
• Publication Date: 2023-03-15T12:58:36Z
• Authors: Bartolomeo Bo; Flaminia Pugnaloni; Amelia Licari; Neil Patel; Brigitte Strizek; Lotte Lemloh; Judith Leyens; Andreas Mueller; Florian Kipfmueller
• Keywords: Ductus arteriosus

Abstract Objective To investigate whether the pattern of flow through ductus arteriosus (DA) is associated with need for extracorporeal membrane oxygenation support (ECMO) or death in neonates congenital diaphragmatic hernia (CDH). Design Retrospective observational study. Setting German level III Neonatal Intensive Care Unit. Participants 139 CDH were born between March 2009 and May 2021. Methods DA was assessed echocardiograms obtained within 24 h life by measuring time velocity integral (VTI) both left‐to‐right (LR) right‐to‐left (RL) components ductal shunt. A VTI ratio (VTILR/VTIRL) < 1.0 an RL relative (Flow timeRL/(Flow timeLR+Flow timeRL)) >33% defined as markers abnormal patterns. The primary outcome ECMO. secondary death. Results 72 patients (51.8%) had a <1.0, 73 (52.5%) >33%. 59 (42.4%) alteration values. Need ECMO present 37.4% ( n = 52), while 19.4% 27) died. <1.0 highest diagnostic accuracy ECMO, (sensitivity 82.7%, specificity 66.7%, negative predictive value [NPV] 86.6%, positive [PPV] 59.7%) well 77.8%, 54.5%, NPV 91.0%, PPV 29.2%). Patients 4.7 times more likely to 3.3 die. values correlated significantly pulmonary hypertension (PH) severity r ‐0.516, p 0.001). Conclusions valuable threshold identify high‐risk neonates. For improved risk stratification, other parameters—for example, left ventricular cardiac dysfunction—should be combined assessment.