Early prostacyclin therapy beneficial to infants with congenital diaphragmatic hernia

In neonates with congenital diaphragmatic hernia (CDH), early treatment with prostacyclin appears to reduce the need for extracorporeal life support in the postnatal period, according to a study.

For the study, data from the CDH Study Group (CDHSG) registry of individuals born from January 2007 to December 2019 were used. All participants had to be admitted to the hospital for CDH within the first week of life.

Neonates who received early prostacyclin therapy were matched to those who did not receive the therapy using propensity score matching. The propensity score was based on estimated gestational age, birth weight, transfer status, 1-minute and 5-minute Apgar scores, highest and lowest partial pressure of arterial carbon dioxide in the first 24 hours of life, and degree of pulmonary hypertension.

A total of 6,227 infants met the inclusion criteria (mean gestational age 37.4 weeks, 42 percent girls). Of these, 206 (3.3 percent) received early prostacyclin therapy and 6,021 did not. The primary outcome of the number of infants who received extracorporeal life support was 46 in the treatment group and 1,682 in the nonexposed group (22.2 percent vs 27.9 percent).

Propensity-score matching analysis included 147 infants each in the treatment and control groups. Early prostacyclin treatment was associated with lower odds of receiving extracorporeal life support (adjusted odds ratio, 0.39, 95 percent confidence interval [CI], 0.22–0.68) and shorter mean duration of extracorporeal life support (8.6 vs 12.6 days; p<0.001). However, exposure to prostacyclin had no effect on in-hospital mortality as compared with nonexposure.

The findings suggest that early prostacyclin therapy may help prevent resource-intense, high-morbidity therapy in neonates with CDH.