Congenital heart disease and arrhythmia disorders in newborns with congenital diaphragmatic hernia: a 23-year experience at a UK university pediatric surgical centre
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In brief
In brief
This 23-year retrospective study of 173 CDH newborns found 55% had coexisting congenital heart disease, requiring increased cardiovascular support and ventilatory interventions. A small subset (2.3%) developed cardiac arrhythmias strongly associated with pulmonary hypertension risk, with nearly half requiring treatment.
- 55% of CDH newborns had congenital heart disease, requiring increased inotrope support and high-frequency oscillatory ventilation.
- CDH babies with arrhythmias had significantly higher risk of pulmonary hypertension (66.7% vs 28.7%, p=0.01).
- Only 2.3% of CDH patients developed cardiac rhythm disorders, with 44% requiring interventional treatment.
- Congenital heart disease in CDH was not associated with increased mortality risk (OR 2.58, 95% CI 0.81-8.24, p=0.11).
- CDH with CHD linked to lower birth weights and greater need for advanced ventilatory support, but similar ECMO and patch repair rates.
Written by the GCMD Library team from the article.
Abstract
Purpose
Congenital diaphragmatic hernia (CDH) is associated with congenital heart disease (CHD) and index newborns reportedly may experience cardiac arrhythmia disorders [Tella et al.—Pediatric Critical Care Medicine 2022]. This study analyses, details and reports contemporary outcome metrics of CHD and cardiac rhythm disease (CRD) in CDH babies attending a university surgical centre.
Methods
Retrospective analysis of medical records of all newborns undergoing Bochdalek CDH repair between 1999 and 2021 at a university paediatric surgical centre. CDH newborns with CHD and neonatal arrythmias were identified from echocardiogram and electrocardiogram (ECG) investigative studies. Operative native diaphragm and / or use of patch repair(s) was documented. Outcome(s) measured—(i) mortality and (ii) cardiopulmonary interventions including ventilatory strategies—ECMO (%), inotropes and anti-arrhythmic therapy(s).
Results
Of 173 CDH neonates, 95 (55%) had CHD of which 9 babies (10%) had cardiac arrhythmias. CDH and co-existing CHD was linked with (a) lower infant birth weights (3130 g vs 3357 g, p = 0.05), (b) increased use of inotrope agents (48.4% vs 39.3%, p = 0.03) and (c) greater use of high-frequency oscillatory ventilation (38.9% vs 23%, p = 0.004). CDH babies experiencing arrythmias were at higher risk (%) of developing pulmonary hypertension (66.7% vs 28.7%, p = 0.01). No significant differences were observed in ECMO utilisation (12% vs 6%, p = 0.46) or patch repair(s) (53% vs 46%, p = 0.06) in CDH patients with and without CHD. CHD was not associated with increased risk(s) of mortality (OR 2.58, 95% CI 0.81–8.24, p = 0.11). Of 9 index CDH patients with arrhythmias—4 babies (44%) required interventional treatments.
Conclusion
CHD was prevalent in a high percentage (%) of CDH newborns treated at this university centre and associated with increased use (%) of cardiovascular respiratory support including patch repair. A minority of patients (2.3%) had cardiac rhythm disorders requiring treatment(s). In those developing arrhythmias pulmonary hypertension may be a risk-linked event. Optimising outcomes to offset pulmonary hypertension requires further appraisal. Future large-scale population studies may help underscore the ‘real apparent incidence’ of cardiac rhythm disorders in CDH.