Article Impact Level: HIGH Data Quality: STRONG Summary of JAMA Pediatrics. https://doi.org/10.1001/jamapediatrics.2023.0405 Dr. Akila Ramaraj et al.
Points
- Prostacyclin (PGI2) treats pulmonary hypertension in neonates with congenital diaphragmatic hernia (CDH).
- A cohort study evaluated the impact of early PGI2 therapy on the need for extracorporeal life support (ECLS) and outcomes in CDH patients.
- Among 6,227 patients, 3.3% received early PGI2 therapy, and 22.2% required ECLS, compared to 27.9% in the non-exposed group.
- After propensity score matching, patients who received early PGI2 were less likely to require ECLS (adjusted odds ratio, 0.39) and had a shorter duration of ECLS.
- There was no significant difference in in-hospital mortality between the groups, suggesting a potential advantage of early prostacyclin therapy in CDH patients.
Summary
Prostacyclin (PGI2) is a therapeutic option for treating pulmonary hypertension associated with congenital diaphragmatic hernia (CDH) in neonates. Using PGI2 can reduce the need for extracorporeal life support (ECLS). This study assessed the relationship between early PGI2 therapy and ECLS utilization and outcomes in CDH patients. The researchers conducted a cohort study using data from the CDH Study Group registry, including patients born between January 2007 and December 2019 from 88 pediatric referral centers worldwide. Propensity score matching was used to create matched groups of exposed and unexposed patients, and the primary outcome was the proportion of patients receiving ECLS.
Of the 6,227 patients meeting the inclusion criteria, 206 (3.3%) received early PGI2 therapy. Among these patients, 22.2% required ECLS, compared to 27.9% in the non-exposed group. After matching propensity scores, the treatment and control groups comprised 147 patients. In the treatment group, 23.3% received ECLS, while in the control group, 42.9% required ECLS. Patients receiving early PGI2 were less likely to require ECLS (adjusted odds ratio, 0.39; 95% CI, 0.22-0.68), and if ECLS was needed, the duration was shorter (8.6 [3.73] days vs. 12.6 [6.61] days; P < .001). However, there was no significant difference in in-hospital mortality.
These findings suggest that early PGI2 therapy in the first week of life is associated with a reduced need for ECLS and a shorter duration of ECLS in CDH patients. The study highlights the potential benefit of initiating prostacyclin therapy early in this patient population.
Link to the article: https://jamanetwork.com/journals/jamapediatrics/article-abstract/2803660
References Ramaraj, A. B., Rice-Townsend, S. E., Foster, C. L., Yung, D., Jackson, E. O., Ebanks, A. H., Harting, M. T., Stark, R. A., Congenital Diaphragmatic Hernia Study Group, Lally, K., Lally, P., & Boyd, Y. (2023). Association between early prostacyclin therapy and extracorporeal life support use in patients with congenital diaphragmatic hernia. JAMA Pediatrics. https://doi.org/10.1001/jamapediatrics.2023.0405
