Fetal MRI Mediastinal Shift Angle, Respiratory and Cardiovascular Pharmacological Support in Newborns With Congenital Diaphragmatic Hernia

Abstract Introduction. In newborns with congenital diaphragmatic hernia (CDH), the mediastinal shift caused by the herniated organs negatively affects lung development. Assessment of the fetal magnetic resonance imaging (MRI) mediastinal shift angle (MSA) was shown to have an inverse correlation with the total fetal lung volume (TFLV), being associated with neonatal survival. However, a possible association with postnatal morbidity has never been investigated. We hypothesize that the degree of the mediastinal shift could be associated with higher respiratory and cardiocirculatory impairment, requiring intensive treatments and extended hospitalization in survivors.Method. We retrospectively consider a cohort of isolated, left-sided CDH, for whom we calculated the MSA and the observed/expected (O/E) TFLV at fetal MRI. We performed a data collection regarding inotropic or vasoactive support, treatment with pulmonary vasodilators, mechanical ventilation, and length of stay. General linear models were performed. Results. The MSA and O/E TFLV were inversely correlated (Pearson’s coefficient -0.65, p < 0.001) and deceased patients showed higher MSA values then survivors (p = 0.011). Among survivors, an increase in MSA was associated with longer pharmacological treatments (dobutamine: p = 0.016; dopamine: p = 0.049; hydrocortisone: p = 0.003; nitric oxide: p = 0.002; sildenafil: p = 0.039; milrinone: p = 0.039; oxygen: p = 0.066), and mechanical ventilation (p = 0.005), with an increasing trend in the length of hospitalization (p = 0.089). Conclusions. The MSA indirectly reflects lung hypoplasia and is associated with the higher neonatal intensity of cares. Further studies are needed to consolidate the results. Clinical Trial Registration: The study is an exploratory post-hoc analysis of the registered NeoAPACHE protocol at ClinicalTrials.gov with the identifier NCT04396028