Echocardiographic predictors of outcome in newborns with congenital diaphragmatic hernia

Objective. Despite new treatments, congenital diaphragmatic hernia (CDH) st ill has high mortality. The aim of this study was to identify echocardiogra phic predictors of outcome in newborns with an isolated CDH. Methods. We reviewed medical charts and echocardiograms of 40 newborns who presented with CDH in the first 24 hours of life, from 1992 to 1996. We com pared the cardiac valves and great arteries diameters, left-ventricular vol ume and mass, Apgar scores, and modified McGoon index (the combined diamete r of hilar pulmonary arteries, indexed to the descending aorta) of survivor s and nonsurvivors. We performed Student's t test and multiple logistic reg ression analysis between the 2 groups. Results. Fourteen patients died 1 to 33 days after birth (median: 3 days), including 8 from progressive hypoxemia without operation; 26 have survived up to 5 years (median: 2 years) after successful operations. Nonsurvivors h ad significantly smaller diameters of right and left hilar pulmonary arteri es, more frequent right-sided CDH, and lower mean Apgar scores at 1 and 5 m inutes. The most significant prognostic factor was the modified McGoon inde x. A modified McGoon index less than or equal to 1.3 predicted mortality wi th a sensitivity of 85% and specificity of 100%. Conclusion. Echocardiographic measurement of hilar pulmonary arteries, whic h may represent the adequacy of the pulmonary vascular bed, is a strong pro gnostic factor for newborns with congenital CDH.