Congenital diaphragmatic hernia: is the heart the problem?

Abstract

Congenital diaphragmatic hernia (CDH) continues to be one of the most challenging conditions in neonatal intensive care. Despite the wide adoption of lung protective strategies for pulmonary hypoplasia and selective vasodilators for pulmonary hypertension, the overall number of babies cannulated for extracorporeal support (ECMO) has been largely unchanged over the last decade. Even more puzzling is that randomized trials did not find any benefit of inhaled nitric oxide (iNO) in reducing need for ECMO in babies with CDH. In this volume of The Journal, Altit et al add an important piece to the CDH puzzle. By assessing conventional and speckle tracking echocardiographic findings for infants that did or did not require ECMO, they found that the degree of pulmonary hypertension was nearly identical in the 2 groups. On the other hand, the babies that required ECMO had evidence for significantly diminished left ventricular function, possibly due to left ventricular hypoplasia. Poor left ventricular function would be expected to increase left atrial and pulmonary venous pressures, and would also explain the poor response to iNO, a pulmonary arterial dilator. Understanding and addressing the cardiac pathophysiology associated with CDH is likely to create substantial improvements in the algorithms of care in the initial days after birth. Article page 28 ▶ Ventricular Performance is Associated with Need for Extracorporeal Membrane Oxygenation in Newborns with Congenital Diaphragmatic HerniaThe Journal of PediatricsVol. 191PreviewTo compare echocardiography (ECHO) findings of patients with congenital diaphragmatic hernia (CDH) who required extracorporeal membrane oxygenation (ECMO) to non-ECMO treated patients. Full-Text PDF