Echocardiographic predictors of adverse outcomes in infants with congenital diaphragmatic hernia

OBJECTIVE: To determine the relationship between echocardiography indices of heart function and adverse short-term outcomes in infants with congenital diaphragmatic hernia (CDH). STUDY DESIGN: This was a retrospective cohort study of infants with CDH from four neonatal surgical centres between 2018 and 2021. Serial targeted neonatal echocardiography was performed to assess myocardial function. The composite primary outcome was death or invasive mechanical ventilation beyond postnatal day 14. RESULTS: We identified 44 infants, and 18 (40.9%) met the composite primary outcome. They had lower pre-operative left ventricular output (110 vs. 157 mL/kg/min, p = 0.002), right ventricular output (114 vs. 187 mL/kg/min, p = 0.008), and peak systolic myocardial velocities measured at the mitral annulus (4.6 vs. 5.4 cm/s, p = 0.006) and interventricular septum (4.2 vs. 4.8 cm/s, p = 0.001). They exhibited lower post-operative right ventricular output (155 vs. 237 mL/kg/min, p = 0.021) and lower myocardial velocities on tissue Doppler imaging. CONCLUSION: Echocardiographic assessments may provide critical prognostic information regarding post-operative respiratory trajectories.