Rameshwar Prasad1, Bijan Saha2, Amit Kumar3. 1. Department of Neonatology, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India. drrameshwarprasad@hotmail.com. 2. Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India. 3. Department of Neurology, Rajendra Institute of Medical Sciences, Ranchi Jharkhand, India.
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.
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.
Authors: Luc Mertens; Istvan Seri; Jan Marek; Romaine Arlettaz; Piers Barker; Patrick McNamara; Anita J Moon-Grady; Patrick D Coon; Shahab Noori; John Simpson; Wyman W Lai Journal: Eur J Echocardiogr Date: 2011-10
Authors: Amish Jain; Adel Mohamed; Afif El-Khuffash; Kim A Connelly; Frederic Dallaire; Robert P Jankov; Patrick J McNamara; Luc Mertens Journal: J Am Soc Echocardiogr Date: 2014-09-23 Impact factor: 5.251
Authors: Pramod Puligandla; Erik Skarsgard; Martin Offringa; Ian Adatia; Robert Baird; Michelle Bailey; Mary Brindle; Priscilla Chiu; Arthur Cogswell; Shyamala Dakshinamurti; Hélène Flageole; Richard Keijzer; Douglas McMillan; Titilayo Oluyomi-Obi; Thomas Pennaforte; Thérèse Perreault; Bruno Piedboeuf; S. Patricia Riley; Greg Ryan; Anne Synnes; Michael Traynor Journal: CMAJ Date: 2018-01-29 Impact factor: 8.262
Authors: Ryan P Barbaro; Matthew L Paden; Yigit S Guner; Lakshmi Raman; Lindsay M Ryerson; Peta Alexander; Viviane G Nasr; Melania M Bembea; Peter T Rycus; Ravi R Thiagarajan Journal: ASAIO J Date: 2017 Jul/Aug Impact factor: 2.872
Authors: Luke R Putnam; Matthew T Harting; Kuojen Tsao; Francesco Morini; Bradley A Yoder; Matías Luco; Pamela A Lally; Kevin P Lally Journal: Pediatrics Date: 2016-11 Impact factor: 7.124
Authors: Kitty G Snoek; Irwin K M Reiss; Anne Greenough; Irma Capolupo; Berndt Urlesberger; Lucas Wessel; Laurent Storme; Jan Deprest; Thomas Schaible; Arno van Heijst; Dick Tibboel Journal: Neonatology Date: 2016-04-15 Impact factor: 4.035
Authors: Maria D Politis; Eva Bermejo-Sánchez; Mark A Canfield; Paolo Contiero; Janet D Cragan; Saeed Dastgiri; Hermien E K de Walle; Marcia L Feldkamp; Amy Nance; Boris Groisman; Miriam Gatt; Adriana Benavides-Lara; Paula Hurtado-Villa; Kärin Kallén; Danielle Landau; Nathalie Lelong; Jorge Lopez-Camelo; Laura Martinez; Margery Morgan; Osvaldo M Mutchinick; Anna Pierini; Anke Rissmann; Antonin Šípek; Elena Szabova; Wladimir Wertelecki; Ignacio Zarante; Marian K Bakker; Vijaya Kancherla; Pierpaolo Mastroiacovo; Wendy N Nembhard Journal: Ann Epidemiol Date: 2020-11-27 Impact factor: 3.797
Authors: Yigit S Guner; Patrick T Delaplain; Lishi Zhang; Matteo Di Nardo; Thomas V Brogan; Yanjun Chen; John P Cleary; Peter T Yu; Matthew T Harting; Henri R Ford; Danh V Nguyen Journal: ASAIO J Date: 2019-07 Impact factor: 2.872