Related Experiment Video
Updated: Nov 17, 2025
Hemodynamic Precision in the Neonatal Intensive Care Unit using Targeted Neonatal Echocardiography
Published on: January 27, 2023
Exploratory Assessment of Levosimendan in Infants With Congenital Diaphragmatic Hernia
Lukas Schroeder1, Kristina Gries, Fabian Ebach
1All authors: Department of Neonatology and Pediatric Intensive Care Medicine, University Children's Hospital Bonn, Bonn, Germany.
Insights
Levosimendan improved cardiac function and reduced pulmonary hypertension in infants with congenital diaphragmatic hernia (CDH). This study observed positive hemodynamic changes within seven days of treatment, despite a significant mortality rate in this critical patient group.
Area of Science:
- Neonatal Cardiology
- Pediatric Critical Care
- Congenital Diaphragmatic Hernia Research
Background:
- Infants with congenital diaphragmatic hernia (CDH) often experience significant cardiac dysfunction and pulmonary hypertension postnatally.
- Severe cases may present with catecholamine-refractory low-cardiac-output failure and persistent pulmonary hypertension, necessitating advanced therapeutic strategies.
Purpose of the Study:
- To investigate the clinical and hemodynamic effects of levosimendan in neonates diagnosed with congenital diaphragmatic hernia.
- To assess the impact of levosimendan on pulmonary hypertension and biventricular dysfunction in this vulnerable population.
Main Methods:
- Retrospective single-center cohort study involving 24 infants with CDH treated with levosimendan.
- Data collected from January 2017 to December 2018 at a tertiary-care children's hospital neonatal ICU.
- Analysis focused on cardiac function, pulmonary hypertension severity, and vasoactive-inotropic support before and after levosimendan administration.
Main Results:
- Levosimendan treatment was associated with significant improvements in pulmonary hypertension severity and right ventricular dysfunction within 7 days.
- Left ventricular dysfunction decreased notably from 50% at baseline to 10% after 7 days of treatment.
- A significant reduction in peak inspiratory pressure and the Vasoactive-Inotropic Score was observed; one infant experienced hypotension as an adverse event.
Conclusions:
- This study provides initial evidence suggesting levosimendan may improve hemodynamic parameters in infants with CDH.
- Observed improvements in pulmonary hypertension and biventricular function warrant further investigation.
- The retrospective nature necessitates cautious interpretation of findings; further prospective studies are recommended.
Objectives:
Infants with congenital diaphragmatic hernia frequently suffer from cardiac dysfunction and pulmonary hypertension during the postnatal course. With the use of the inodilator levosimendan, a therapeutic approach is available in situations with catecholamine-refractory low-cardiac-output failure and severe pulmonary hypertension.
Design:
Retrospective single-center cohort study.
Setting:
University-based, tertiary-care children's hospital neonatal ICU.
Patients:
Cohort of 24 infants with congenital diaphragmatic hernia and levosimendan therapy, without underlying major cardiac defect, treated at the University Children´s Hospital Bonn, Germany, between January 2017 and December 2018.
Interventions:
None.
Measurements And Main Results:
Twenty-four infants with congenital diaphragmatic hernia were treated with levosimendan (41% of hospitalized congenital diaphragmatic hernia infants in the study period). In 88%, the congenital diaphragmatic hernia was left-sided. The median observed-to-expected lung-to-head ratio was 36%. About 60% of the infants were supported with venovenous extracorporeal membrane oxygenation and the mortality was 38% (9/24 infants). Levosimendan administration was associated with improvement of pulmonary hypertension severity (p = 0.013 and p = 0.000) and right ventricular dysfunction (p = 0.011 and p = 0.000) at 24 hours and 7 days after treatment. Similarly, the prevalence of left ventricular dysfunction decreased from 50% at baseline to 10% after 7 days (p = 0.026). A significant reduction in the peak inspiratory pressure was observed after drug application (p = 0.038) and a significant decrease of the Vasoactive-Inotropic Score was apparent (p = 0.022). A relevant arterial hypotension as a drug-related adverse event occurred in one patient.
Conclusions:
This is the first study exploring clinical and hemodynamic changes after levosimendan treatment in a cohort of infants with congenital diaphragmatic hernia. An association of levosimendan application and an improvement in pulmonary hypertension, right ventricular, and left ventricular dysfunction were observed within 7 days after drug infusion. However, due to the retrospective design of this study, the results should be interpreted carefully.
More Related Videos
11:27A Modified Sonographic Algorithm for Image Acquisition in Life-Threatening Emergencies in the Critically Ill Newborn
Published on: April 7, 2023
08:21Functional Assessment of the Donor Heart During Ex Situ Perfusion: Insights from Pressure-Volume Loops and Surface Echocardiography
Published on: October 11, 2022
Related Concept Videos
01:23Mitral Stenosis II: Clinical features and Diagnostic Tests
01:29Assessment of Ventilation II: Respiratory Depth and Rhythm
Respiratory depth measures the volume of air inhaled or exhaled during a breath. It can vary from shallow to deep and typically remains consistent when a person is at rest or asleep. Occasionally, individuals will automatically inhale deeply, known as sighing, which inflates the lungs with more air than normal breathing.
To assess respiratory depth, observe the degree of chest excursion or movement:
01:22Mitral Valve Prolapse II: Assessment and Management