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Ventricular function in congenital diaphragmatic hernia: a systematic review and meta-analysis

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Abstract

There is emerging evidence supporting ventricular function as a prognostic factor in congenital diaphragmatic hernia (CDH). The present systematic review and meta-analysis aimed to determine the predictive value of early ventricular function for survival and extracorporeal membrane oxygenation (ECMO) requirement in newborns with CDH. PubMed, Google Scholar, Cochrane Central Register, Clinical Trial Registry, and Opengrey were accessed. Studies evaluating associations between echocardiographic ventricular function measured ≤ 48 h after birth and survival or ECMO requirement were included. Two independent authors extracted the following data: study and participant characteristics, prognostic factors, and outcome-related data. Eleven studies met the inclusion criteria. Five studies reported on survival, two on ECMO, and four on both outcomes. A moderate risk of bias was found in most of the studies, mainly because of selection, prognostic factors, and confounding biases. For survival (899 participants), pooled sensitivity and specificity were 86% (95% confidence interval [CI], 77–92%) and 44% (95% CI, 25–65%), respectively, in normal left ventricular function. For ECMO need (815 participants), pooled sensitivity and specificity were 39.8% (95% CI, 27–52%) and 88% (95% CI, 80–96%), respectively, in left ventricular dysfunction. Overall certainty of the evidence was graded very low for survival and low for ECMO. Inconsistent reporting of echocardiographic measurements and lack of adjustment for confounding factors were major limitations.

Conclusion: Early ventricular dysfunction is a potential prognostic factor in CDH. Standardized echocardiographic measurement reporting and high-quality studies are needed to further elucidate its prognostic significance.

What is Known:

• Evidence supports the predictive value of echocardiographic measurements in CDH ≤ 24–48 h post-birth.

• Ventricular dysfunction has been proposed as a prognostic risk factor.

What is New:

• Right and left ventricular functions were promising predictors of survival and ECMO requirement in neonates with CDH.

• Test characteristics of ventricular function were determined as predictors of survival or need for ECMO. Specific echocardiographic markers of ventricular function can be valuable in determining prognosis.

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Availability of data and material

All data relevant to the study are included in the article or uploaded as supplementary information.

Code availability

STATA statistical software version 13 (College Station, TX, USA: StataCorp LP) and RevMan.

Abbreviations

AUC:

Area under ROC curve

BW:

Birth weight

CDH:

Congenital diaphragmatic hernia

CDHSG:

Congenital Diaphragmatic Hernia Study Group

CI:

Confidence interval

DOR:

Diagnostic odds ratio

ECMO:

Extracorporeal membrane oxygenation

EF:

Ejection fraction

FAC:

Fractional area change

GA:

Gestational age

GRADE:

Grades of Recommendation, Assessment, Development, and Evaluation

iNO:

Inhaled nitric oxide

LH + :

Positive likelihood ratio

LR − :

Negative likelihood ratio

LV:

Left ventricle

LVOT:

LV outflow tract

MD:

Mean difference

MeSH:

Medical Subject Headings

PH:

Pulmonary hypertension

QUIPS:

Quality in Prognosis Studies

RoB:

Risk of bias

RV:

Right ventricle

RVOT:

RV outflow tract

SROC:

Summary receiver operating characteristic

TAPSE:

Tricuspid annular plane systolic excursion

VTI:

Velocity time integer

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Acknowledgements

We would like to thank the authors of the studies who responded to our requests and provided access to additional data.

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Authors and Affiliations

  1. Department of Neonatology, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India

    Rameshwar Prasad

  2. Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India

    Bijan Saha

  3. Department of Neurology, Rajendra Institute of Medical Sciences, Ranchi Jharkhand, India

    Amit Kumar

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Conception (Rameshwar Prasad and Bijan Saha), design (Rameshwar Prasad, Bijan Saha, and Amit Kumar), data acquisition (Rameshwar Prasad and Amit Kumar), analysis (Rameshwar Prasad and Amit Kumar), writing initial draft (Rameshwar Prasad and Amit Kumar), critical revision (Rameshwar Prasad, Bijan Saha, Amit Kumar). All authors approved the final manuscript as submitted and agreed to be accountable for all aspects of the work.

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Prasad, R., Saha, B. & Kumar, A. Ventricular function in congenital diaphragmatic hernia: a systematic review and meta-analysis. Eur J Pediatr 181, 1071–1083 (2022). https://doi.org/10.1007/s00431-021-04303-9

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