Early postnatal right-to-left patent ductus arteriosus shunting and severe outcomes in neonates with congenital diaphragmatic hernia: a retrospective cohort study
Abstract Background Congenital diaphragmatic hernia (CDH) is a severe anomaly associated with significant pulmonary hypertension (PH) and high mortality, often requiring extracorporeal membrane oxygenation (ECMO). Early prognostic markers are essential to guide clinical decisions. This study evaluat...
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BMC
2025-08-01
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| Series: | BMC Pediatrics |
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| Online Access: | https://doi.org/10.1186/s12887-025-05986-x |
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| author | Jung Il Kwak Juhee Park Mi Jin Kim Kyusang Yoo Bo Kyeong Jin Tae-Gyeong Kim Joo Hyung Roh Ha Na Lee Keon Hee Seol Chae Young Kim Soo Hyun Kim Jiyoon Jeong Byong Sop Lee Euiseok Jung |
| author_facet | Jung Il Kwak Juhee Park Mi Jin Kim Kyusang Yoo Bo Kyeong Jin Tae-Gyeong Kim Joo Hyung Roh Ha Na Lee Keon Hee Seol Chae Young Kim Soo Hyun Kim Jiyoon Jeong Byong Sop Lee Euiseok Jung |
| author_sort | Jung Il Kwak |
| collection | DOAJ |
| description | Abstract Background Congenital diaphragmatic hernia (CDH) is a severe anomaly associated with significant pulmonary hypertension (PH) and high mortality, often requiring extracorporeal membrane oxygenation (ECMO). Early prognostic markers are essential to guide clinical decisions. This study evaluated the prognostic value of right-to-left (R-L) shunting in the patent ductus arteriosus (PDA) during the early postnatal period in predicting ECMO use and mortality in neonates with CDH. Methods This retrospective cohort study included neonates with CDH admitted between 2013 and 2024. Echocardiographic evaluations within 24 h of birth categorized PDA shunting as left-to-right (L-R), R-L, or bidirectional. Outcomes were analyzed using two models. First, the pure R-L shunt group was compared with the combined L-R and bidirectional shunt groups. Second, bidirectional shunts were subclassified as L-R or R-L predominant based on Doppler spectral area, with the R-L predominant group analyzed together with the pure R-L shunt group and the L-R predominant group analyzed with the L-R shunt group. Primary outcomes were ECMO use or mortality, analyzed using logistic regression. Results Among 145 neonates, both models demonstrated that R-L shunting was associated with a higher ECMO requirement or increased mortality rate compared to L-R shunting (p < 0.001). Multivariate analysis identified R-L shunting as an independent predictor of adverse outcomes (Model 1: odds ratio [OR] 6.785, 95% confidence interval [CI] 2.333–19.730; p < 0.001; Model 2: OR 4.067, 95% CI 1.444–11.455; p = 0.008). Conclusion The direction of early postnatal R-L PDA shunt, assessed within 24 h of birth, was significantly associated with ECMO use or mortality in neonates with CDH. |
| format | Article |
| id | doaj-art-90717a8d9c71424e88ebe7ba90fc7d34 |
| institution | Kabale University |
| issn | 1471-2431 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Pediatrics |
| spelling | doaj-art-90717a8d9c71424e88ebe7ba90fc7d342025-08-24T11:50:38ZengBMCBMC Pediatrics1471-24312025-08-012511710.1186/s12887-025-05986-xEarly postnatal right-to-left patent ductus arteriosus shunting and severe outcomes in neonates with congenital diaphragmatic hernia: a retrospective cohort studyJung Il Kwak0Juhee Park1Mi Jin Kim2Kyusang Yoo3Bo Kyeong Jin4Tae-Gyeong Kim5Joo Hyung Roh6Ha Na Lee7Keon Hee Seol8Chae Young Kim9Soo Hyun Kim10Jiyoon Jeong11Byong Sop Lee12Euiseok Jung13Division of Neonatology, Department of Pediatrics, Asan Medical Center Children’s Hospital, University of Ulsan College of MedicineDivision of Neonatology, Department of Pediatrics, Asan Medical Center Children’s Hospital, University of Ulsan College of MedicineDivision of Neonatology, Department of Pediatrics, Asan Medical Center Children’s Hospital, University of Ulsan College of MedicineDivision of Neonatology, Department of Pediatrics, Asan Medical Center Children’s Hospital, University of Ulsan College of MedicineDivision of Neonatology, Department of Pediatrics, Asan Medical Center Children’s Hospital, University of Ulsan College of MedicineDivision of Neonatology, Department of Pediatrics, Asan Medical Center Children’s Hospital, University of Ulsan College of MedicineDivision of Neonatology, Department of Pediatrics, Asan Medical Center Children’s Hospital, University of Ulsan College of MedicineDivision of Neonatology, Department of Pediatrics, Asan Medical Center Children’s Hospital, University of Ulsan College of MedicineDivision of Neonatology, Department of Pediatrics, Asan Medical Center Children’s Hospital, University of Ulsan College of MedicineDivision of Neonatology, Department of Pediatrics, Asan Medical Center Children’s Hospital, University of Ulsan College of MedicineDivision of Neonatology, Department of Pediatrics, Asan Medical Center Children’s Hospital, University of Ulsan College of MedicineDivision of Neonatology, Department of Pediatrics, Asan Medical Center Children’s Hospital, University of Ulsan College of MedicineDivision of Neonatology, Department of Pediatrics, Asan Medical Center Children’s Hospital, University of Ulsan College of MedicineDivision of Neonatology, Department of Pediatrics, Asan Medical Center Children’s Hospital, University of Ulsan College of MedicineAbstract Background Congenital diaphragmatic hernia (CDH) is a severe anomaly associated with significant pulmonary hypertension (PH) and high mortality, often requiring extracorporeal membrane oxygenation (ECMO). Early prognostic markers are essential to guide clinical decisions. This study evaluated the prognostic value of right-to-left (R-L) shunting in the patent ductus arteriosus (PDA) during the early postnatal period in predicting ECMO use and mortality in neonates with CDH. Methods This retrospective cohort study included neonates with CDH admitted between 2013 and 2024. Echocardiographic evaluations within 24 h of birth categorized PDA shunting as left-to-right (L-R), R-L, or bidirectional. Outcomes were analyzed using two models. First, the pure R-L shunt group was compared with the combined L-R and bidirectional shunt groups. Second, bidirectional shunts were subclassified as L-R or R-L predominant based on Doppler spectral area, with the R-L predominant group analyzed together with the pure R-L shunt group and the L-R predominant group analyzed with the L-R shunt group. Primary outcomes were ECMO use or mortality, analyzed using logistic regression. Results Among 145 neonates, both models demonstrated that R-L shunting was associated with a higher ECMO requirement or increased mortality rate compared to L-R shunting (p < 0.001). Multivariate analysis identified R-L shunting as an independent predictor of adverse outcomes (Model 1: odds ratio [OR] 6.785, 95% confidence interval [CI] 2.333–19.730; p < 0.001; Model 2: OR 4.067, 95% CI 1.444–11.455; p = 0.008). Conclusion The direction of early postnatal R-L PDA shunt, assessed within 24 h of birth, was significantly associated with ECMO use or mortality in neonates with CDH.https://doi.org/10.1186/s12887-025-05986-xHerniaDiaphragmaticMortalityExtracorporeal membrane oxygenationEchocardiographyPatent ductus arteriosus |
| spellingShingle | Jung Il Kwak Juhee Park Mi Jin Kim Kyusang Yoo Bo Kyeong Jin Tae-Gyeong Kim Joo Hyung Roh Ha Na Lee Keon Hee Seol Chae Young Kim Soo Hyun Kim Jiyoon Jeong Byong Sop Lee Euiseok Jung Early postnatal right-to-left patent ductus arteriosus shunting and severe outcomes in neonates with congenital diaphragmatic hernia: a retrospective cohort study BMC Pediatrics Hernia Diaphragmatic Mortality Extracorporeal membrane oxygenation Echocardiography Patent ductus arteriosus |
| title | Early postnatal right-to-left patent ductus arteriosus shunting and severe outcomes in neonates with congenital diaphragmatic hernia: a retrospective cohort study |
| title_full | Early postnatal right-to-left patent ductus arteriosus shunting and severe outcomes in neonates with congenital diaphragmatic hernia: a retrospective cohort study |
| title_fullStr | Early postnatal right-to-left patent ductus arteriosus shunting and severe outcomes in neonates with congenital diaphragmatic hernia: a retrospective cohort study |
| title_full_unstemmed | Early postnatal right-to-left patent ductus arteriosus shunting and severe outcomes in neonates with congenital diaphragmatic hernia: a retrospective cohort study |
| title_short | Early postnatal right-to-left patent ductus arteriosus shunting and severe outcomes in neonates with congenital diaphragmatic hernia: a retrospective cohort study |
| title_sort | early postnatal right to left patent ductus arteriosus shunting and severe outcomes in neonates with congenital diaphragmatic hernia a retrospective cohort study |
| topic | Hernia Diaphragmatic Mortality Extracorporeal membrane oxygenation Echocardiography Patent ductus arteriosus |
| url | https://doi.org/10.1186/s12887-025-05986-x |
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