Congenital heart disease and congenital diaphragmatic hernia: the role of intracardiac shunts

Jenna A Katz; Philip T Levy; Isabella Zaniletti; Molly K Ball; Ruth Seabrook; Shazia Bhombal; Karna Murthy; Michael A Padula; Sharada H Gowda; Theresa R Grover; Sarah D Keene; Children’s Hospitals Neonatal Consortium’s (CHNC) Congenital Diaphragmatic Hernia Focus Group

doi:10.1038/s41372-026-02584-2

Congenital heart disease and congenital diaphragmatic hernia: the role of intracardiac shunts

J Perinatol. 2026 Mar 2. doi: 10.1038/s41372-026-02584-2. Online ahead of print.

Authors

Jenna A Katz^{1

2}, Philip T Levy^{3

4}, Isabella Zaniletti⁵, Molly K Ball⁶, Ruth Seabrook⁶, Shazia Bhombal^{7

8}, Karna Murthy^{9

10}, Michael A Padula^{5

11

12}, Sharada H Gowda¹³, Theresa R Grover¹⁴, Sarah D Keene^{7

8}; Children’s Hospitals Neonatal Consortium’s (CHNC) Congenital Diaphragmatic Hernia Focus Group

Affiliations

¹ Division of Newborn Medicine, Boston Children's Hospital, Boston, MA, USA. jenna.katz@childrens.harvard.edu.
² Department of Pediatrics, Harvard Medical School, Boston, MA, USA. jenna.katz@childrens.harvard.edu.
³ Division of Newborn Medicine, Boston Children's Hospital, Boston, MA, USA.
⁴ Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
⁵ Children's Hospitals Neonatal Consortium, Dover, DE, USA.
⁶ Division of Neonatology, Department of Pediatrics, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
⁷ Children's Healthcare of Atlanta, Atlanta, GA, USA.
⁸ Division of Neonatal-Perinatal Medicine, Emory University School of Medicine, Atlanta, MA, USA.
⁹ Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
¹⁰ IL and Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
¹¹ Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
¹² Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
¹³ Division of Neonatology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA.
¹⁴ Section of Neonatology, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA.

PMID: 41772101
DOI: 10.1038/s41372-026-02584-2

Abstract

Objective: To evaluate the impact of cardiac lesions on outcomes to discharge in infants with congenital diaphragmatic hernia (CDH).

Study design: Retrospective analysis of infants with CDH identified in the Children's Hospitals Neonatal Database (CHND) from 2010 to 22. Patients were stratified into groups based on associated congenital heart disease (CHD): (1) noCHD (2) CDH + atrial, ventricular septal defects (avCHD); (3) CDH + severe CHD (sevCHD).

Results: Among 2940 neonates with CDH, 570 (19%) had CHD (453 avCDH, 117 sevCHD). CHD of any severity was associated with small for gestational age at birth, a 5 minute Apgar <5, and additional anomalies or syndromes (p < 0.05 for all). Mechanical ventilation days, use of extra-corporeal membrane oxygenation, length of stay, and mortality increased with CHD severity (p < 0.005). Home medical needs were more frequent in infants with associated CHD (p < 0.001).

Conclusions: Comorbid CHD of any severity adds complexity and risk to patients with CDH.