Background: In congenital diaphragmatic hernia (CDH), infants with left heart disease are at highest risk of extracorporeal membrane oxygenation (ECMO) and mortality, but the association between maternal-fetal environmental characteristics and these adverse post-natal outcomes is unknown. Methods: Maternal-fetal dyads with CDH enrolled in a single-center Birth Defects Biorepository who were also enrolled in comprehensive post-natal echocardiographic studies from 2019-2023 were included in a retrospective analysis. Geocoded census tract was used to generate maternal neighborhood characteristics from conception to birth from the American Community Survey (ACS), Childhood Opportunity Index, Air Quality Index (AQI) and Food and Drug Administration percent food insecurity. Infant characteristics including ECMO and survival were abstracted from the biorepository. Quantification of left heart hypoplasia and/or left ventricular (LV) dysfunction was performed on post-natal echocardiograms. Disease-specific and neighborhood characteristics were compared by ECMO/mortality status and by presence of left heart disease. Results: Seventy-seven patients (58% male, 82% left CDH, 68% liver herniation) were included. Twenty-four (31%) required ECMO, 61 (77%) had left heart hypoplasia or LV dysfunction, and 19 (25%) received pulmonary vasodilators. ECMO utilization was higher in patients with left heart disease. Worse neighborhood air quality by AQI was identified in patients who required ECMO and/or died and in patients with left heart disease. A higher percentage of female-headed households was seen in patients who required ECMO and/or died. Conclusions: Maternal neighborhood characteristics may impact outcomes in CDH. Future study of these environmental factors may inform individualized treatment strategies.
Avitabile et al. (Fri,) studied this question.