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Published on: January 27, 2023
Early, Postnatal Pulmonary Hypertension Severity Predicts Inpatient Outcomes in Congenital Diaphragmatic Hernia
Dalya Munves Ferguson1,2, Vikas S Gupta1,2, Pamela A Lally1
1John P. and Katherine G. McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas, USA.
Insights
Early pulmonary hypertension in infants with congenital diaphragmatic hernia (CDH-PH) is linked to higher mortality and oxygen support rates. Echocardiograms can predict these outcomes in neonates with CDH.
Area of Science:
- Neonatal Medicine
- Pediatric Cardiology
- Respiratory Medicine
Background:
- Pulmonary hypertension (PH) is a critical complication of congenital diaphragmatic hernia (CDH).
- Early identification of PH in neonates with CDH is crucial for predicting inpatient outcomes.
Purpose of the Study:
- To assess the association between early CDH-associated PH (CDH-PH) and inpatient outcomes in neonates.
- To determine the prognostic value of early echocardiography in CDH patients.
Main Methods:
- Retrospective analysis of the CDH Study Group registry (2015-2019).
- Echocardiograms obtained within 48 hours of birth were used to categorize PH severity (none, mild, moderate, severe).
- Adjusted Poisson regression analyzed the composite outcome of 30-day mortality or oxygen support and ECLS utilization.
Main Results:
- 86.5% of 1,472 infants had CDH-PH, with 13.9% mild, 44.4% moderate, and 33.2% severe.
- Moderate and severe CDH-PH were independently associated with increased risk of 30-day mortality or oxygen support.
- Severe CDH-PH was associated with increased extracorporeal life support (ECLS) utilization.
Conclusions:
- Early postnatal CDH-PH is an independent predictor of adverse inpatient outcomes, including mortality and need for oxygen support.
- Severe CDH-PH is specifically linked to higher rates of ECLS use.
- Early echocardiography serves as a valuable prognostic tool for neonates with CDH.
Introduction:
Pulmonary hypertension (PH) is the major pathophysiologic consequence of congenital diaphragmatic hernia (CDH). We aimed to evaluate the association between early CDH-associated PH (CDH-PH) and inpatient outcomes.
Methods:
The CDH Study Group registry was queried for infants born 2015-2019 with echocardiograms before 48h of life. PH was categorized using echocardiographic findings: none, mild (right ventricular systolic pressure <2/3 systemic), moderate (between 2/3 systemic and systemic), or severe (supra-systemic). Univariate and multivariate analyses were performed. Adjusted Poisson regression was used to assess the primary composite outcome of mortality or oxygen support at 30 days.
Results:
Of 1,472 patients, 86.5% had CDH-PH: 13.9% mild (n = 193), 44.4% moderate (n = 631), and 33.2% severe (n = 468). On adjusted analysis, the primary outcome of mortality or oxygen support at 30 days occurred more frequently in infants with moderate (incidence rate ratio [IRR] 1.8, 95% confidence interval [CI], 1.2-2.6) and severe CDH-PH (IRR 2.0, 95% CI, 1.3-2.9). Extracorporeal life support (ECLS) utilization was associated only with severe CDH-PH after adjustment (IRR 1.8, 95% CI, 1.0-3.3).
Discussion/Conclusion:
Early, postnatal CDH-PH is independently associated with increased risk for mortality or oxygen support at 30 days and utilization of ECLS. Early echocardiogram is a valuable prognostic tool for early, inpatient outcomes in neonates with CDH.
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