NeoAPACHE Study Protocol Ii. Relationship Between Radiographic Pulmonary Area and Pulmonary Hypertension, Mortality, and Hernia Recurrence in Newborns With CDH.

To investigate the relationship between radiographic lung area and systolic pulmonary artery pressure (sPAP) on the first day of life, mortality, and hernia recurrence during the first year of life in infants with a congenital diaphragmatic hernia (CDH). Retrospective cohort study on 77 CDH newborns. Lung area was calculated by tracing the lung’s perimeter, excluding mediastinal structures and herniated organs, on the preoperative chest X-ray performed within 24 hours after birth. Echocardiographic sPAP value, deaths, and recurrence cases were recorded. Logistic and linear regression analyses were performed. Deceased infants showed lower areas and higher sPAP values. One cm2 of rising in the total, ipsilateral, and contralateral area was associated with a 22%, 43%, and 24% reduction in mortality risk. sPAP values showed a decreasing trend at birth, with a maximum of 1.84 mmHg reduction per unitary increment in the ipsilateral area. Recurrence patients showed lower areas, with recurrence risk decreasing by 14% and 29% per unit increment of the total and ipsilateral area.In CDH patients, lung area at birth reflects impaired lung development and defect size, being associated with increased sPAP values, mortality, and recurrence risk.Clinical Trial Registration: The trial was registered at ClinicalTrials.gov with identifier NCT04396028.