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Association Between Fetal Pulmonary Artery Acceleration Time/Ejection Time Ratio and Postnatal Inhaled Nitric Oxide
Kyoko Namimatsu1, Yuka Yamamoto1, Rie Seyama1
1Department of Obstetrics and Gynecology, Juntendo University, Bunkyo-ku, Japan.
Objective:
To evaluate whether fetal pulmonary artery (PA) measurements and PA Doppler parameters such as acceleration time/ejection time (AT/ET) ratio predict respiratory outcomes in surviving neonates with left-sided congenital diaphragmatic hernia (CDH).
Methods:
This retrospective single-center study included fetuses with left-sided CDH born between 2016 and 2024. Fetal echocardiography assessed PA Doppler parameters, including the AT/ET ratio, peak early diastolic reverse flow, and pulsatility index. Neonatal morbidity using the use of inhaled nitric oxide (iNO) was analyzed in relation to prenatal ultrasound parameters.
Results:
27 fetuses with left-sided CDH were analyzed, and 3 neonates died. Among 23 survivors without structural abnormalities, the fetal contralateral PA AT/ET ratio was significantly lower in the iNO group (p = 0.019) and negatively correlated with iNO duration (r = -0.57). ROC analysis showed that an AT/ET cut-off of 0.17 predicted iNO use with 63% sensitivity and 100% specificity.
Conclusion:
In this study, the AT/ET ratio correlated with postnatal iNO use in fetuses with left-sided CDH. It can be measured non-invasively, and may be useful for risk stratification and prenatal parental counseling.
