Continuous physiological data to assess pulmonary hypertension and cardiac dysfunction in neonates with congenital diaphragmatic hernia

This study presents a proof-of-concept for continuous data-driven monitoring of pulmonary hypertension (PH) and cardiac dysfunction (CD) in neonates with congenital diaphragmatic hernia (CDH) using routine monitoring data. Retrospective observational study in the pediatric intensive care unit (PICU) in a tertiary, university children’s hospital. Neonates with CDH admitted between 2019 and 2022 who underwent echocardiography within 30 days of admission were eligible. Vital signs, electrocardiography (ECG) and mechanical ventilation data were extracted in a 15-minute window before echocardiography to calculate medians and interquartile ranges (IQR), heart rate variability (HRV) and oxygen saturation index (OSI). Outcomes were dichotomized as no-to-moderate versus severe PH and without versus with CD (left, right or combined). Logistic mixed effect models were developed and validated during leave-one-out cross-validation. In total 57 patients with 129 echocardiograms were included, of which 73 no-to-moderate PH (56.6%) versus 56 severe PH (43.4%); 70 without CD (54.3%) versus 59 with CD (45.7%). Features of oxygen saturation and heart rate were significantly associated with PH, while blood pressure and HRV features were significantly associated with CD. The final PH model included oxygen saturation and pulse rate, with 66.7% sensitivity, 65.0% specificity, 63.2% PPV and 68.4% NPV. The final CD model included HRV with 44.4% sensitivity, 75.0% specificity, 61.5% PPV and 60.0% NPV.: This proof-of-concept study shows routine monitoring data are associated with the PH and CD in neonates with CDH and may complement echocardiography. Prospective validation with standardized echocardiography protocols and an established data infrastructure is warranted.