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Prognostic value of echocardiographic parameters in congenital diaphragmatic hernia: a systematic review and meta-analysis
  1. Mohan Pammi1,
  2. Yashaswini Kelagere2,
  3. Sara Koh3,
  4. Amy Sisson4,
  5. Joseph Hagan1,
  6. Joshua Kailin1,
  7. Caraciolo J Fernandes1
  1. 1 Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
  2. 2 Department of Pediatrics, Saint Peters Hospital, New Brunswick, New Jersey, USA
  3. 3 Rice University, Houston, Texas, USA
  4. 4 Texas Medical Center Library, Houston Academy of Medicine, Houston, Texas, USA
  1. Correspondence to Dr Mohan Pammi, Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA; mohanv{at}


Background Prognostication of mortality and decision to offer extracorporeal membrane oxygenation (ECMO) treatment in infants with congenital diaphragmatic hernia (CDH) can inform clinical management.

Objective To summarise the prognostic value of echocardiography in infants with CDH.

Methods Electronic databases Ovid MEDLINE, Embase, Scopus, CINAHL, the Cochrane Library and conference proceedings up to July 2022 were searched. Studies evaluating the prognostic performance of echocardiographic parameters in newborn infants were included. Risk of bias and applicability were assessed using the Quality Assessment of Prognostic Studies tool. We used a random-effect model for meta-analysis to compute mean differences (MDs) for continuous outcomes and relative risk (RR) for binary outcomes with 95% CIs. Our primary outcome was mortality; secondary outcomes were need for ECMO, duration of ventilation, length of stay, and need for oxygen and/or inhaled nitric oxide.

Results Twenty-six studies were included that were of acceptable methodological quality. Increased diameters of the right and left pulmonary arteries at birth (mm), MD 0.95 (95% CI 0.45 and 1.46) and MD 0.79 (95% CI 0.58 to 0.99), respectively) were associated with survival. Left ventricular (LV) dysfunction, RR 2.40, (95% CI 1.98 to 2.91), right ventricular (RV) dysfunction, RR 1.83 (95% CI 1.29 to 2.60) and severe pulmonary hypertension (PH), RR 1.69, (95% CI 1.53 to 1.86) were associated with mortality. Left and RV dysfunctions, RR 3.30 (95% CI 2.19 to 4.98) and RR 2.16 (95% CI 1.85 to 2.52), respectively, significantly predicted decision to offer ECMO treatment. Limitations are lack of consensus on what parameter is optimal and standardisation of echo assessments.

Conclusions LV and RV dysfunctions, PH and pulmonary artery diameter are useful prognostic factors among patients with CDH.

  • child health
  • mortality
  • neonatology
  • paediatrics

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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  • Contributors MP and CJF: guarantors, conceptualised and designed the study. YK and SK: designed the data collection instruments, collected the data, initial analyses. AS: search strategy, data collection. JH: substantial contributions to the analyses and interpretation of the data. JK: data interpretation.

  • Funding MP was funded by the following extramural source: National Institutes of Health (R03HD098482 and R21HD091718).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.