Hemodynamic phenotypes in congenital diaphragmatic hernia and their association with morbidity and mortality
Background: Congenital diaphragmatic hernia (CDH) is a severe condition associated with high morbidity and mortality. Its severity correlates with the degree of pulmonary hypoplasia. Recent literature has emphasized the importance of identifying distinct hemodynamic phenotypes (HP) to guide physiolo...
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2025-01-01
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| author | Daniel Ibarra-Ríos José G. Mantilla-Uresti Diana M. Barrios-Bautista Alejandro Peñarrieta-Daher Cristian R. Zalles-Vidal Deneb A. Morales-Barquet Horacio Márquez-González |
| author_facet | Daniel Ibarra-Ríos José G. Mantilla-Uresti Diana M. Barrios-Bautista Alejandro Peñarrieta-Daher Cristian R. Zalles-Vidal Deneb A. Morales-Barquet Horacio Márquez-González |
| author_sort | Daniel Ibarra-Ríos |
| collection | DOAJ |
| description | Background: Congenital diaphragmatic hernia (CDH) is a severe condition associated with high morbidity and mortality. Its severity correlates with the degree of pulmonary hypoplasia. Recent literature has emphasized the importance of identifying distinct hemodynamic phenotypes (HP) to guide physiology-based management. Method: We included all CDH patients evaluated by targeted neonatal echocardiography from January 2017 to April 2022. HPs were classified into three groups: HP1 (mild pulmonary hypertension [PH] without ventricular dysfunction), HP2 (pre-capillary PH), and HP3 (post-capillary PH). We compared differences between survivors and non-survivors using the Mann–Whitney U-test, analyzed baseline and pre/ post-surgical echocardiographic parameters using the Wilcoxon test, estimated survival curves using Kaplan–Meier analysis, and compared length of stay using the Kruskal–Wallis test. Results: Among 28 included neonates, 24 survived (86%). HP distribution was: HP1 9 patients (32%), HP2 8 patients (29%), and HP3 11 patients (39%). Four patients died, two post-surgery and two without surgical intervention. Mortality-associated factors included higher pCO2, lower left ventricular (LV) output, decreased LV compliance, and elevated pulmonary vascular resistance (PVR). Survival analysis revealed a non-significant trend toward higher mortality in HP2 (one death) and HP3 (three deaths). Follow-up demonstrated progressive increases in biventricular output, PVR reduction, and compensatory cerebral vasodilation. Conclusion: HP correlated with patient mortality, particularly in cases with greater pulmonary hypoplasia (higher CO2) and compromised ventricular performance. Echocardiographic monitoring revealed improvements in biventricular performance, decreased PVR facilitating surgical intervention, and cerebral perfusion adaptation.
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| format | Article |
| id | doaj-art-e34da1f0c4744a2ab9d5b276c1a945a4 |
| institution | DOAJ |
| issn | 0539-6115 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Permanyer |
| record_format | Article |
| series | Boletín Médico del Hospital Infantil de México |
| spelling | doaj-art-e34da1f0c4744a2ab9d5b276c1a945a42025-08-20T02:57:55ZengPermanyerBoletín Médico del Hospital Infantil de México0539-61152025-01-0182110.24875/BMHIM.24000093Hemodynamic phenotypes in congenital diaphragmatic hernia and their association with morbidity and mortalityDaniel Ibarra-Ríos0José G. Mantilla-Uresti1Diana M. Barrios-Bautista2Alejandro Peñarrieta-Daher3Cristian R. Zalles-Vidal4Deneb A. Morales-Barquet5Horacio Márquez-González6Department of Neonatology, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, MexicoDepartment of Neonatology, Hospital General de Soledad de Graciano Sánchez, San Luis Potosí, MexicoDepartment of Neonatology, Unidad Médica de Alta Especialidad, Hospital de Gineco Obstetricia No. 4 Luis Castelazo Ayala, Mexico City, MexicoDepartment of Surgery, Hospital Infantil de México Federico Gómez, Mexico City, MexicoDepartment of Surgery, Hospital Infantil de México Federico Gómez, Mexico City, MexicoDepartment of Neonatology, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Mexico City, MexicoClinical Research Service, Hospital Infantil de México Federico Gómez, Mexico City, MexicoBackground: Congenital diaphragmatic hernia (CDH) is a severe condition associated with high morbidity and mortality. Its severity correlates with the degree of pulmonary hypoplasia. Recent literature has emphasized the importance of identifying distinct hemodynamic phenotypes (HP) to guide physiology-based management. Method: We included all CDH patients evaluated by targeted neonatal echocardiography from January 2017 to April 2022. HPs were classified into three groups: HP1 (mild pulmonary hypertension [PH] without ventricular dysfunction), HP2 (pre-capillary PH), and HP3 (post-capillary PH). We compared differences between survivors and non-survivors using the Mann–Whitney U-test, analyzed baseline and pre/ post-surgical echocardiographic parameters using the Wilcoxon test, estimated survival curves using Kaplan–Meier analysis, and compared length of stay using the Kruskal–Wallis test. Results: Among 28 included neonates, 24 survived (86%). HP distribution was: HP1 9 patients (32%), HP2 8 patients (29%), and HP3 11 patients (39%). Four patients died, two post-surgery and two without surgical intervention. Mortality-associated factors included higher pCO2, lower left ventricular (LV) output, decreased LV compliance, and elevated pulmonary vascular resistance (PVR). Survival analysis revealed a non-significant trend toward higher mortality in HP2 (one death) and HP3 (three deaths). Follow-up demonstrated progressive increases in biventricular output, PVR reduction, and compensatory cerebral vasodilation. Conclusion: HP correlated with patient mortality, particularly in cases with greater pulmonary hypoplasia (higher CO2) and compromised ventricular performance. Echocardiographic monitoring revealed improvements in biventricular performance, decreased PVR facilitating surgical intervention, and cerebral perfusion adaptation. https://www.bmhim.com/frame_eng.php?id=474Congenital diaphragmatic hernia. Echocardiography. Mortality. Hemodynamics. Hemodynamic monitoring. Phenotype. |
| spellingShingle | Daniel Ibarra-Ríos José G. Mantilla-Uresti Diana M. Barrios-Bautista Alejandro Peñarrieta-Daher Cristian R. Zalles-Vidal Deneb A. Morales-Barquet Horacio Márquez-González Hemodynamic phenotypes in congenital diaphragmatic hernia and their association with morbidity and mortality Boletín Médico del Hospital Infantil de México Congenital diaphragmatic hernia. Echocardiography. Mortality. Hemodynamics. Hemodynamic monitoring. Phenotype. |
| title | Hemodynamic phenotypes in congenital diaphragmatic hernia and their association with morbidity and mortality |
| title_full | Hemodynamic phenotypes in congenital diaphragmatic hernia and their association with morbidity and mortality |
| title_fullStr | Hemodynamic phenotypes in congenital diaphragmatic hernia and their association with morbidity and mortality |
| title_full_unstemmed | Hemodynamic phenotypes in congenital diaphragmatic hernia and their association with morbidity and mortality |
| title_short | Hemodynamic phenotypes in congenital diaphragmatic hernia and their association with morbidity and mortality |
| title_sort | hemodynamic phenotypes in congenital diaphragmatic hernia and their association with morbidity and mortality |
| topic | Congenital diaphragmatic hernia. Echocardiography. Mortality. Hemodynamics. Hemodynamic monitoring. Phenotype. |
| url | https://www.bmhim.com/frame_eng.php?id=474 |
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