Impact of inotropic support on outcomes in congenital diaphragmatic hernia: A retrospective cohort study.

Abstract

IntroductionCongenital diaphragmatic hernia (CDH) has complex hemodynamic pathophysiology. There is a paucity of literature to predict outcomes based on the type of medications used for hemodynamic support.MethodsThis is a single-center retrospective cohort. Cases were categorized into different phenotypes: No dysfunction, right ventricle dysfunction, left ventricle dysfunction, and biventricular dysfunction. Medications used for hemodynamic support were categorized into inotropes and vasopressors based on type and dose.StatisticsMean, median, standard deviation, and percentages were used as appropriate. Contingency tables were constructed to compare the distribution of outcomes across different groups. Regression models analyzed the link between hemodynamic phenotype and outcomes.Results69 CDH cases between 2011 and 2023 were analyzed. The mean gestational age at birth was 38.0 weeks (SD 2.4), with a mean birth weight of 3109 g (SD 744 g). The distribution of hemodynamic phenotypes was as follows: No dysfunction phenotype: 43 infants (62.3%), RV phenotype: 7 infants (10.1%), LV phenotype: 7 infants (10.1%), and combined phenotype: 12 infants (17.4%). Inotropes were used in 26 infants (37.7%), vasopressors in 16 infants (23.2%), and a combination of inotropes and vasopressors in 19 infants (27.5%). Outcomes of interest were not different across the different hemodynamic phenotypes. Adjusted logistic regression analysis exploring the impact of LV dysfunction with vasopressor use found higher odds for death (OR = 4.8, p = 0.05).ConclusionInfants with CDH with LV dysfunction and vasopressor exposure are possibly at higher risk for mortality. This is an exploratory finding that warrants further investigation and research to establish the prognosis based on medications used for hemodynamic support.