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Research Article
Giacomo Cavallaro
Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico
Corresponding Author
ORCiD: https://orcid.org/0000-0002-4921-1437
License:
This work is licensed under a CC BY 4.0 License. Read Full License
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
Keywords
Fetal Magnetic Resonance Imaging, Mediastinal Shift Angle, Congenital Diaphragmatic Hernia, pulmonary vasodilators, inotropes
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CURRENT STATUS: Published
View the published article at European Journal of Pediatrics.
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Posted 12 May, 2021
No community comments so far
Editorial decision: Minor Revisions Needed
On 10 Jun, 2021
Reviews received
Received 07 May, 2021
Reviewers invited
Invitations sent on 07 May, 2021
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On 04 May, 2021
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On 04 May, 2021
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Subject Areas
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A new preprint design is coming!
We have improved readability, clarity, accessibility, and opportunities for engagement.
See the published version of this preprint at European Journal of Pediatrics.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research Article
Giacomo Cavallaro
Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico
Corresponding Author
ORCiD: https://orcid.org/0000-0002-4921-1437
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at European Journal of Pediatrics.
Version 1
Posted 12 May, 2021
No community comments so far
Editorial decision: Minor Revisions Needed
On 10 Jun, 2021
Reviews received
Received 07 May, 2021
Reviewers invited
Invitations sent on 07 May, 2021
Editor assigned
On 04 May, 2021
First submitted
On 04 May, 2021
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Pediatrics
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at European Journal of Pediatrics.
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
Figure 1
Figure 2
Figure 3
Figure 4
Figure 5
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