Early hemodynamic phenotype was associated with cardiorespiratory severity and ECMO or death in CDH. LV-involved PH identified a high-risk phenotype and may complement prenatal anatomic risk stratification, although its independent prognostic value beyond prenatal lung size requires validation.
Among 66 infants with CDH who had echocardiography within 24 h of birth, 21 were classified as no/mild PH, 22 as RV-predominant PH, and 23 as LV-involved PH.
The rate of ECMO or death increased stepwise across the hemodynamic phenotypes.
LV-involved PH was associated with greater respiratory severity and more frequent LV dysfunction than RV-predominant PH.
Observed-to-expected lung-to-head ratio (O/E LHR) did not differ significantly between the LV-involved and RV-predominant PH groups.
Ordinal hemodynamic phenotype severity remained associated with ECMO or death after adjustment for O/E LHR.
The direct comparison of LV-involved with RV-predominant PH for ECMO or death was no longer statistically significant after adjustment for O/E LHR.
The authors conclude that LV-involved PH identifies a high-risk phenotype that may complement prenatal anatomic risk stratification, but its independent prognostic value beyond prenatal lung size needs validation.
This study looked at 66 newborns with congenital diaphragmatic hernia (CDH), a birth defect in which a hole in the diaphragm lets abdominal organs push into the chest and limit lung growth. All had a heart ultrasound within 24 hours of birth. The researchers sorted the babies into three groups by how the heart and blood vessels were coping: no or mild high lung blood pressure (pulmonary hypertension), pressure mainly straining the right side of the heart, or strain that also involved the left side of the heart. Outcomes differed sharply between the groups. None of the babies with no or mild pulmonary hypertension needed ECMO (a form of heart-lung bypass support) or died. This happened in about 27% of babies with right-sided strain and about 65% of those with left-sided involvement. Babies with left-sided involvement also had more severe breathing problems. After accounting for prenatal lung size measured before birth, the overall pattern still held. However, the difference between the two higher-risk groups was no longer clearly significant, possibly because the study was small. This research suggests that an early heart ultrasound after birth could add useful information about which babies with CDH are at highest risk, alongside prenatal scans of lung size. The study was retrospective, done at one hospital, and small, so larger studies are needed to confirm whether the heart ultrasound pattern adds prognostic value beyond prenatal measurements.
Yoo K, Kim S, Park J, Kim T, Kwak J, Lee J, et al.. (2026). Early echocardiographic hemodynamic phenotypes and clinical outcomes in congenital diaphragmatic hernia.. European journal of pediatrics. https://doi.org/10.1007/s00431-026-07559-1