89 - Digoxin use in congenital diaphragmatic hernia: a review of cases

Infants with congenital diaphragmatic hernia (CDH) are at risk of pulmonary hypertension (PH) associated cardiac dysfunction for which effective, evidence-based therapies are lacking. Digoxin is used to treat pediatric and adult cardiac dysfunction. B-type natriuretic peptide (BNP) is monitored to assess therapeutic response to digoxin. The utilization of digoxin in infants with CDH is not well described. Further, the impact of digoxin on BNP in this population is unclear. We reviewed digoxin use and its impact on BNP in infants with CDH over a 6-year period.

Objective: We hypothesized that enteral digoxin in repaired CDH infants would improve ventricular dysfunction as suggested by improved B-type natriuretic peptide (BNP) levels.

Design/Methods:

We conducted a retrospective review of infants from 10/2015-12/2021 to assess the use of digoxin and serial BNP levels. All included infants were also on sildenafil for treatment of post-repair CDH-PH and without other anomalies. Paired t-test was used.

Results: 96 infants underwent CDH repair; 34 were included and 7 treated with digoxin. There were no differences between cohorts except the percentage of infants receiving sildenafil at NICU discharge (p=0.046; Table 1). Median BNP level 24 hours prior to digoxin was 420 pg/mL (IQR 209-1312). After 48 hours of digoxin, median BNP level decreased to 218 pg/mL (IQR 73-284; p< 0.001). All digoxin-treated infants showed a decrement in BNP (median 65%, range 40-72%; Table 2).

Conclusion(s): Digoxin is utilized in infants with CDH despite limited data on efficacy or safety. Use may be associated with a reduction in BNP. Further studies with digoxin for CDH-PH associated heart failure, including correlation of BNP levels with echocardiographic measures of PH, is warranted.