Abstract
Purpose
Congenital diaphragmatic hernia (CDH) represents a deviation in lung development and a life-threatening condition with high mortality rate. [1–5] The study aimed to perform a meta-analysis on the efficacy and safety of prostaglandins as vasodilatory agent therapy for Pulmonary Hypertension (PH) in postnatal period in patients with Congenital Diaphragmatic Hernia.
Methods
A systematic search of PubMed, EMBASE, and Cochrane was conducted to identify randomized controlled trials (RCT) and cohorts analyzing the use of PGE1 and PGI versus placebo in CDH patients with PH born after 37 weeks of gestation. The primary outcomes of interest were mortality and ECMO utilization. Statistical analysis followed the Cochrane Collaboration guidelines and Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) recommendations. Heterogeneity was assessed by using Cochrane's Risk of Bias 1 (ROBINS-I), Cochran Q test, and I2 statistics.
Results
The meta-analysis, comprising four cohorts totaling 6,873 patients, revealed that prostaglandins (PG) did not significantly decrease mortality rates as anticipated (RR 1.44; 95% CI 0.89–2.32; p = 0.134; I2 = 64%). However, the confidence interval and p-value indicated a lack of statistical significance.
Conclusion
This meta-analysis has its limitations; we do not establish conclusively the efficacy of PGI and PGE in reducing mortality in CDH patients. However, it may have indicated an association between the use of PGE1 and a reduction in the duration of mechanical ventilation dependency. Further, RCT is imperative to comprehensively assess the utilization of PGI and PGE1 in treating PH in CDH patients.
PROSPERO Identifier CRD42023438338.