Early postnatal echocardiographic assessment of pulmonary blood flow in newborns with congenital diaphragmatic hernia

Author:

Kipfmueller Florian1,Heindel Katrin1,Schroeder Lukas1,Berg Christoph2,Dewald Oliver3,Reutter Heiko14,Bartmann Peter1,Mueller Andreas1

Affiliation:

1. Department of Neonatology and Pediatric Critical Care Medicine , University of Bonn Children’s Hospital , Sigmund-Freud-Str. 25 , 53127 Bonn , Germany

2. Department of Obstetrics and Prenatal Medicine , University of Bonn Medical Center , Sigmund-Freud-Str. 25 , 53127 Bonn , Germany

3. Department of Cardiac Surgery , University of Bonn Medical Center , Sigmund-Freud-Str. 25 , 53127 Bonn , Germany

4. Institute of Human Genetics , University of Bonn Medical Center , Sigmund-Freud-Str. 25 , 53127 Bonn , Germany

Abstract

Abstract Objective: Echocardiography is the most important tool to assess infants with congenital diaphragmatic hernia (CDH) for pulmonary hypertension (PH). The pattern of blood flow in the pulmonary artery [described as time to peak velocity (TPV)/right ventricular ejection time (RVET) ratio] provides distinct information about pulmonary arterial pressure. The aim of our study was to investigate the correlation of TPV/RVET measurements with the most commonly used classification system for PH in CDH newborns and the association of these measurements with outcome parameters. Methods: Echocardiographic measurements were obtained in 40 CDH newborns within 6 h of life. The obtained measurements were correlated with the decision for or against extracorporeal membrane oxygenation (ECMO); early mortality; total duration of mechanical ventilation and total duration of oxygen supplementation. Results: The correlation coefficient between severity of PH and TPV/RVET measurements was −0.696 (P<0.001). Using receiver operating characteristic (ROC) analyses the optimal cutoff for TPV/RVET in order to predict the necessity for ECMO or early mortality without ECMO was 0.29 with a sensitivity of 86.7%, a specificity of 68%, a positive predictive value of 61.9% and a negative predictive value of 89.5%. Newborns with a TPV/RVET below the cutoff had a 5.9-fold risk for ECMO or early mortality, a significantly longer duration of mechanical ventilation (13.4 days vs. 7.4 days, P=0.003) and oxygen supplementation (22.4 days vs. 9.0 days, P=0.019), and a lower survival rate (76.2% vs. 100%, P=0.021). Conclusions: TPV/RVET is a feasible parameter to assess PH in CDH newborns with close correlation to outcome parameters.

Publisher

Walter de Gruyter GmbH

Subject

Obstetrics and Gynaecology,Pediatrics, Perinatology, and Child Health

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