Hemodynamic monitoring using MostCare (PRAM) in neonates with congenital diaphragmatic hernia

Objective: To evaluate the trends of hemodynamic parameters in neonates with congenital diaphragmatic hernia (CDH) monitored using MostCare (PRAM) during the pre-, intra-, and postoperative periods, and to assess the association between cardiac index (CI) and indicators of tissue perfusion. Methods: This prospective observational study included neonates with CDH monitored using PRAM during the first 48 hours of life and throughout the perioperative period (6 hours before surgery, intraoperatively, and 6 hours after surgery). A linear mixed-effects model with subject-specific random intercepts was used to analyze the association between CI and clinical perfusion indicators (heart rate, arterial blood pressure, lactate levels, vasoactive inotropic score, urine output, pH, and base excess). Cerebral and renal tissue oxygenation, assessed by near-infrared spectroscopy (NIRS) and expressed as fractional tissue oxygen extraction (FTOE), was also evaluated. Results: CI showed significant correlations with systemic vascular resistance index (SVRI), stroke volume index (SVI), arterial blood pressure (systolic and diastolic), and heart rate (p < 0.05). The time variable was significant (p = 0.012), indicating variations in CI during the observation period. No significant associations were observed with lactate levels, pH, base excess, vasoactive inotropic score, or NIRS-derived parameters. Conclusions: PRAM monitoring was feasible and provided useful information in neonates with CDH, allowing dynamic assessment of CI, which was closely related to major hemodynamic parameters. This study represents the first investigation conducted in this neonatal population.