{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T09:19:13Z","timestamp":1787649553257,"version":"build-2736575974"},"reference-count":60,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T00:00:00Z","timestamp":1787616000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>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.<\/jats:p>","DOI":"10.3390\/children13091137","type":"journal-article","created":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T08:00:48Z","timestamp":1787644848000},"page":"1137","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Hemodynamic Phenotypes in Congenital Diaphragmatic Hernia: Unresolved Questions and Future Directions"],"prefix":"10.3390","volume":"13","author":[{"suffix":"Jr.","given":"John T.","family":"Wren","sequence":"first","affiliation":[{"name":"Department of Pediatrics, University of Iowa, Iowa City, IA 52240, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neil","family":"Patel","sequence":"additional","affiliation":[{"name":"Department of Neonatology, Royal Hospital for Children, Glasgow G51 4TF, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7648-8872","authenticated-orcid":false,"given":"Patrick J.","family":"McNamara","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Iowa, Iowa City, IA 52240, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Sloan","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Washington University in St. Louis, St. Louis, MO 63110, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1148\/radiol.2442061158","article-title":"Lung volumes in fetuses with congenital diaphragmatic hernia: Comparison of 3D US and MR imaging assessments","volume":"244","author":"Jani","year":"2007","journal-title":"Radiology"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e720","DOI":"10.1542\/neo.24-11-e720","article-title":"Unique Cardiopulmonary Interactions in Congenital Diaphragmatic Hernia: Physiology and Therapeutic Implications","volume":"24","author":"Johng","year":"2023","journal-title":"NeoReviews"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"151439","DOI":"10.1016\/j.sempedsurg.2024.151439","article-title":"Ventilator strategies in congenital diaphragmatic hernia","volume":"33","author":"Kunisaki","year":"2024","journal-title":"Semin. 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