Tydén Katarina Övermo, Magnusson Kerstin, Burgos Carmen Mesas, Jonsson Baldvin, Nordenstam Felicia
Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
Department of Pediatric Cardiology, Karolinska University Hospital, Stockholm, Sweden.
Front Pediatr. 2025 Jul 17;13:1598695. doi: 10.3389/fped.2025.1598695. eCollection 2025.
Neonates with congenital diaphragmatic hernia (CDH) often present with pulmonary hypertension and various forms of cardiac dysfunction, affecting right or left ventricle or both. Although pulmonary hypertension typically improves over time, some children experience long term pulmonary hypertension. There is limited understanding of cardiac function recovery. The authors hypothesized that cardiac function in the CDH population would remain impaired during the first 2-5 weeks of life compared with in a control group.
This prospective observational cohort study included 40 newborns with CDH and 40 controls born in 2021-2024 and cared for at Karolinska University Hospital, Stockholm, Sweden. The first study echocardiograms were performed between 6 and 24 h of age. Subsequently, 23 of the 40 CDH cases were also examined at 2-5 weeks of age. Left ventricular longitudinal strain (LV LS), right ventricle free wall strain (RVFWS), left atrial reservoir strain (LASr), right atrial reservoir strain (RASr), and conventional echo parameters were analyzed.
Newborns with CDH had reduced cardiac function measured with LV LS [mean -14.7% (standard deviation 4.6) vs. -18.8% (2.7), < 0.001], RVFWS [-13.9% (4.2) vs. 22.4% (4.8) < 0.001], LASr [22.8% (9.3) vs. 33.9% (8.2), < 0.001], and RASr [21.8% (6.9) vs. 37.6% (9.2), < 0.001], compared with controls. Cardiac strain had improved for all subjects at the age of 2-5 weeks. However, the cases with CDH still had lower strain than the controls.
Cardiac function measured as strain was reduced in newborns with CDH compared with in a control group. Although their cardiac function improved over time, it remained lower compared to the control group at 2-5 weeks of age.
先天性膈疝（CDH）新生儿常伴有肺动脉高压和各种形式的心脏功能障碍，影响右心室、左心室或两者。虽然肺动脉高压通常会随着时间推移而改善，但一些儿童会经历长期肺动脉高压。目前对心脏功能恢复的了解有限。作者推测，与对照组相比，CDH患儿在出生后的前2至5周内心脏功能仍会受损。
这项前瞻性观察队列研究纳入了2021年至2024年在瑞典斯德哥尔摩卡罗林斯卡大学医院出生并接受治疗的40例CDH新生儿和40例对照组新生儿。首次超声心动图检查在出生后6至24小时进行。随后，40例CDH病例中的23例在2至5周龄时也接受了检查。分析了左心室纵向应变（LV LS）、右心室游离壁应变（RVFWS）、左心房储存应变（LASr）、右心房储存应变（RASr）和传统超声心动图参数。
与对照组相比，CDH新生儿的LV LS[平均值-14.7%（标准差4.6）对-18.8%（2.7），<0.001]、RVFWS[-13.9%（4.2）对22.4%（4.8），<0.001]、LASr[22.8%（9.3）对33.9%（8.2），<0.001]和RASr[21.8%（6.9）对37.6%（9.2），<0.001]所测量的心脏功能降低。所有受试者在2至5周龄时心脏应变均有所改善。然而，CDH病例的应变仍低于对照组。
与对照组相比，CDH新生儿以应变测量的心脏功能降低。虽然他们的心脏功能随时间有所改善，但在2至5周龄时仍低于对照组。
