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Hemodynamic Phenotypes in Congenital Diaphragmatic Hernia: Unresolved Questions and Future Directions
Journal article   Open access   Peer reviewed

Hemodynamic Phenotypes in Congenital Diaphragmatic Hernia: Unresolved Questions and Future Directions

John T. Wren, Neil Patel, Patrick J. McNamara and Patrick Sloan
Children (Basel), Vol.13(9), p.1137
08/25/2026
DOI: 10.3390/children13091137
PMCID: PMC13605828
PMID: 42794157
url
https://doi.org/10.3390/children13091137View
Published (Version of record) Open Access

Abstract

Congenital diaphragmatic hernia (CDH) is increasingly recognized as a dynamic cardiopulmonary disease in which pulmonary hypoplasia, pulmonary hypertension, and cardiac dysfunction interact to shape clinical instability, therapeutic response, and outcomes. Hemodynamic phenotyping has emerged as a strategy to move beyond binary classification of pulmonary hypertension and toward physiology-directed care. Early single-center experiences suggest potential clinical utility of echocardiography-guided, phenotype-directed management; however, external validation remains limited. Further important challenges remain, including technical and institutional barriers to timely echocardiography, limitations of static single-time-point assessments, uncertainty regarding what exactly defines each phenotype, and incomplete understanding of the impact of time and therapies on phenotype presentations. In this perspective, we summarize the evolution of heart-focused care in CDH, describe current hemodynamic phenotyping approaches, examine unresolved questions in phenotype classification and implementation, and outline future research priorities needed to advance dynamic, mechanism-based precision cardiopulmonary care for infants with CDH.
 congenital diaphragmatic hernia hemodynamic phenotypes echocardiography pulmonary hypertension neonatal hemodynamics

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