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Pulmonary hypertension in congenital diaphragmatic hernia: Antenatal prediction and impact on neonatal mortality

Basurto, David; Russo, Francesca Maria; Papastefanou, Ioannis; Bredaki, Emma; Allegaert, Karel; Pertierra, Africa; Debeer, Anne; ... Deprest, Jan; + view all (2022) Pulmonary hypertension in congenital diaphragmatic hernia: Antenatal prediction and impact on neonatal mortality. Prenatal Diagnosis , 42 (10) pp. 1303-1311. 10.1002/pd.6207. Green open access

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Abstract

Objective: To determine the prevalence of pulmonary hypertension (PAH) in left-sided congenital diaphragmatic hernia (CDH); how we could predict it; and how PAH contributed to the model for mortality prediction. Study Design: Retrospective analysis in three European centers. The primary outcome was the presence of PAH on postnatal day (d) 1, 7, and at discharge. Studied predictors of PAH were: observed/expected-lung/head-ratio (o/e LHR), liver-herniation, fetoscopic endoluminal tracheal occlusion (FETO), and gestational age (GA) at delivery. The combined effect of pre- and postnatal variables on mortality was modeled by Cox regression. Results: Of the 197 neonates, 56 (28.4%) died. At d1, 67.5% (133/197) had PAH and 61.9% (101/163) by d7. Overall, 6.4% (9/141) had PAH at discharge. At d1, o/e LHR (odds ratio (OR) 0.96) and FETO (OR 2.99) independently correlated to PAH (areas under the curve [AUC]: 0.74). At d7, PAH significantly correlated only with the use of FETO (OR 3.9; AUC: 0.65). None were significant for PAH at discharge. Combining the occurrence of PAH with antenatal biomarkers improved mortality prediction (p = 0.02), in a model including o/e LHR (HR: 0.94), FETO (HR: 0.35), liver herniation (HR: 16.78), and PAH (HR: 15.95). Conclusions: Antenatal prediction of PAH was only moderate. The postnatal occurrence of PAH further increases the risk of death. Whereas this may be used to counsel parents in the postnatal period, our study demonstrates there is a need to find more accurate antenatal predictors for PAH.

Type: Article
Title: Pulmonary hypertension in congenital diaphragmatic hernia: Antenatal prediction and impact on neonatal mortality
Location: England
Open access status: An open access version is available from UCL Discovery
DOI: 10.1002/pd.6207
Publisher version: https://doi.org/10.1002/pd.6207
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: FETUSES, Genetics & Heredity, INFANTS, INTRAPULMONARY ARTERIAL DOPPLER, Life Sciences & Biomedicine, LUNG SIZE, MORBIDITY, Obstetrics & Gynecology, PARAMETERS, Science & Technology, STANDARDIZED POSTNATAL MANAGEMENT, SURVIVAL, TO-HEAD RATIO, TRACHEAL OCCLUSION
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health > Developmental Biology and Cancer Dept
URI: https://discovery.ucl.ac.uk/id/eprint/10179314
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