Meta-analysis of prostacyclin therapy for persistent pulmonary hypertension with congenital diaphragmatic hernia.

Shouliang Jiang; Xue Han; Yang He; Qian Gao; Juan Liang; Tingting Zhu; Li Zhang; Jun Tang

doi:10.1016/j.jpedsurg.2026.163301

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Meta-analysis of prostacyclin therapy for persistent pulmonary hypertension with congenital diaphragmatic hernia.

Shouliang Jiang·Xue Han·Yang He·Qian Gao·Juan Liang·Tingting Zhu·Li Zhang·Jun Tang

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Abstract

OBJECTIVE: To evaluate the efficacy and safety of prostacyclin in the treatment of persistent pulmonary hypertension in congenital diaphragmatic hernia. METHODS: A systematic literature search was conducted in four main databases (PubMed, Web of Science, EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL). The protocol was registered in advance in the International Prospective of Systematic Reviews (CRD420261325458). RESULTS: A total of nine studies were included involving a total of 7009 infants in this systematic review and meta-analysis. GRADE assessment revealed substantial heterogeneity in the quality of evidence across outcomes, with most outcomes rated very low quality and only one rated moderate quality. Studies were performed meta-analysis, which showed the use of prostacylin resulted a statistically significant decrease in the OI compared to the control group (Mean Difference (MD), 9.34; I2 0%; p < 0.00001), no statistically significant in mortality (OR, 0.83; I2 84%; p = 0.70), ECMO (OR = 4.9; I2 98%; p = 0.27), BNP (std MD, 6.98; I2 98%; p = 0.31), FiO2 (SMD = 8.0;, I2 64%; p = 0.11), Systolic orientation of IVS curvature (SMD = 0.69; I2 97%; p = 0.32), Diastolic orientation of IVS differences (MD = 0.62; I2 93% p = 0.26). After applying the Hartung-Knapp adjustment, with the exception of BNP, the pooled effects of the other outcomes were not statistically significant, and there was high heterogeneity in measures such as ECMO and ventricular septal curvature. CONCLUSION: In conclusion, this meta-analysis has confirmed that prostacyclin may temporarily improve oxygenation. However, after applying the Hartung-Knapp adjustment, with the exception of BNP, the pooled effects of the other outcomes were not statistically significant, and there was high heterogeneity in measures such as ECMO and ventricular septal curvature. Further validation through high-quality studies are still needed. TRIAL REGISTRATION: PROSPERO: CRD420261325458.

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Humans Hernias, Diaphragmatic, Congenital Epoprostenol Antihypertensive Agents Treatment Outcome Persistent Fetal Circulation Syndrome Infant, Newborn Hypertension, Pulmonary Extracorporeal Membrane Oxygenation CDH Congenital diaphragmatic hernia PPHN Prostacyclin Pulmonary hypertension of the newborn Treprostinil Journal Article Systematic Review Meta-Analysis Review

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Shouliang Jiang, Xue Han, Yang He, Qian Gao, Juan Liang, Tingting Zhu, Li Zhang, Jun Tang. 2026-07-23. Meta-analysis of prostacyclin therapy for persistent pulmonary hypertension with congenital diaphragmatic hernia.. https://doi.org/10.1016/j.jpedsurg.2026.163301

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Extracorporeal Membrane Oxygenation subject Humans subject Infant, Newborn subject Journal Article subject Journal Article; Systematic Review; Meta-Analysis; Review resource Meta-Analysis subject Systematic reviews study

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