Prediction of neonatal respiratory function and pulmonary hypertension in fetuses with isolated congenital diaphragmatic hernia in the fetal endoscopic tracleal occlusion era: a single-center study.

Abstract

OBJECTIVE:

To correlate prenatal indicators of pulmonary hypoplasia with neonatal lung function and pulmonary hypertension (PHT) in isolated congenital diaphragmatic hernia (iCDH).

MATERIALS AND METHODS:

Prospective single-center study on 40 fetuses with iCDH either expectantly managed (n = 13) or undergoing tracheal occlusion (n = 27). Prenatal predictors included observed/expected lung-head ratio (O/E LHR), observed/expected total fetal lung volume, fetal pulmonary reactivity to maternal O2 administration (Δpulsatility index, ΔPI) and liver-to-thorax ratio (LiTR) as measured in the second and third trimesters. Postnatal outcome measures included survival until discharge, best oxygenation index (OI) and alveolar-arterial oxygen gradient [D(A-a)O2] in the first 24 h of life and the occurrence of PHT in the first 28 days of life.

RESULTS:

Median gestational age (GA) at evaluations was 27.2 and 34.3 weeks. GA at delivery was 36.0 weeks, and overall survival was 55%. In the second trimester, measurement of lung size, LiTR and pulmonary reactivity were significantly related to survival and the best OI and D(A-a)O2.The occurrence of PHT was better predicted by ΔPI and LiTR.

CONCLUSIONS:

O/E LHR, LiTR and vascular reactivity correlate with ventilatory parameters in the first 24 h of life. Occurrence of PHT at ≥28 days was best predicted by LiTR and ΔPI, but not by lung size.

• Authors: Elisa Done, Anne Debeer, Leonardo Gucciardo, Tim Van Mieghem, Paul Lewi, Roland Devlieger, Luc De Catte, Liesbeth Lewi, Karel Allegaert, Jan Deprest
• Journal: Fetal diagnosis and therapy (Fetal Diagn Ther) Vol. 37 Issue 1 Pg. 24-32 ( 2015) ISSN: 1421-9964 [Electronic] Switzerland
• PMID: 25402437 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © 2014 S. Karger AG, Basel.

Topics

• Abnormalities, Multiple (diagnostic imaging, physiopathology)
• Female
• Gestational Age
• Hernias, Diaphragmatic, Congenital (diagnostic imaging, physiopathology)
• Humans
• Hypertension, Pulmonary (diagnostic imaging, physiopathology)
• Infant, Newborn
• Lung (abnormalities, diagnostic imaging, physiopathology)
• Lung Diseases (diagnostic imaging, physiopathology)
• Lung Volume Measurements
• Pregnancy
• Pregnancy Outcome
• Prenatal Diagnosis
• Prospective Studies
• Ultrasonography, Prenatal