Postnatal Lung Growth and Nutrition in Congenital Diaphragmatic Hernia Outcomes

CDH occurs in approximately 1 in 3,000 births, with referral centers seeing 20 to 30 babies per year.

CDH is often identified on initial ultrasound at roughly 20 weeks of pregnancy, when other anomalies may also be identified that can greatly impact outcome.

Overall survival for infants born with CDH remains static at about 70% over the past two decades despite intensive care efforts.

Very little imaging has been done to study what happens to CDH lungs after birth, specifically whether and how the lungs grow postnatally.

Ultra-short echoT MRI allows determination of postnatal lung volumes, lung density, and lung mass.

In a cohort of 13 CDH babies at Cincinnati Children's, postnatal lungs do grow: total lung volume, right lung volume, and left lung volume all increase.

The non-CDH (right) lung grows better than the CDH (left) lung, with the left lung growing approximately 2 mL per week slower than the right lung.

Relative growth of the left (CDH) lung increases in babies with better weight gain.

Maximizing calories and protein intake to maximize growth is important because growth is associated with better growth of the more severely hypoplastic lung.

Babies who gained weight better had more growth of their left (CDH) lung mass, but weight gain did not impact the mass of the right lung.

2D time-of-flight MRI can detect blood vessels in the lungs down to a size of 0.7 millimeters, allowing quantitation of vascular volume divided by lung volume to calculate vascular density.

CDH pulmonary vascular density correlates very strongly with outcomes in babies with CDH.

Lower vascular density is associated with longer time spent on the ventilator.

Babies discharged on room air had significantly higher vascular density than those discharged on oxygen or mechanical ventilation.