Early Ductal Shunting Patterns in Neonates with Congenital Diaphragmatic Hernia Predict Clinical Outcomes

Abstract Objective We sought to compare the clinical outcomes in newborns with congenital diaphragmatic hernia (CDH) who have continuous right-to-left versus intermittent or no right-to-left shunting across the patent ductus arteriosus (PDA). Methods Retrospective study of 125 patients with CDH was done. Clinical outcomes were compared based on Doppler flow patterns through the PDA on initial echocardiogram. Results A total of 93 patients were included. Newborns with continuous right-to-left flow (N = 20) had a significantly increased risk of mortality (35% vs. 13.7%; P = 0.047), need for ECMO (80% vs. 33%; P < 0.001), number of pulmonary hypertension therapies (median 2.5 vs. 1; P < 0.001), and respiratory support. There was no difference in total length of stay or qualitative ventricular function. There was a significantly higher proportion of males among infants with continuous right-to-left ductal flow (P = 0.028). Conclusion Continuous right-to-left shunting across the PDA in neonates with CDH is associated with increased mortality and worse clinical outcomes.