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Updated: May 5, 2026
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Published on: February 5, 2021
Initial Hemodynamic Phenotypes and Clinical Trajectory in Congenital Diaphragmatic Hernia: A Pilot Study
John T Wren1, Rachael M Hyland1, Patrick J McNamara1
1Division of Neonatology, Department of Pediatrics, University of Iowa Healthcare, Iowa City, IA.
Objectives:
To define clinically the initial (<24 hour) hemodynamic phenotypes (no/mild pulmonary hypertension [PH], precapillary PH, and postcapillary PH) in neonates with congenital diaphragmatic hernia (CDH) by echocardiography, and to assess their relationship with clinical outcomes.
Study Design:
This was a retrospective, single-center, observational study that included all neonates with CDH with an echocardiogram in the first 24 hours from 2018 to 2025. Phenotypes were categorized via an a priori-defined algorithm, characterized by clinical and echocardiography indices and were evaluated for association with mortality, need for extracorporeal life support, and key clinical outcomes.
Results:
Despite bidirectional atrial and/or ductal shunts in every echocardiogram (n = 28), phenotype identification was feasible with 2 (7%) no/mild PH, 18 (64%) precapillary PH, and 8 (29%) postcapillary PH phenotype. There was no association between phenotype and mortality or extracorporeal life support; however, the postcapillary phenotype was associated with earlier mortality, decreased surgical repair, and mortality when exposed to inhaled nitric oxide.
Conclusions:
An algorithmic approach that includes early echocardiography can reliably identify hemodynamic phenotypes even in the presence of bidirectional shunts. Phenotypes may have distinct clinical trajectories in neonates with CDH.
