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Prediction of neonatal respiratory function and pulmonary hypertension in fetuses with isolated congenital diaphragmatic hernia in the fetal endoscopic tracleal occlusion era

Journal Contribution - Journal Article

Subtitle:a single-center study

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.

Journal: Fetal Diagnosis & Therapy
ISSN: 1015-3837
Issue: 1
Volume: 37
Pages: 24-32
Publication year:2015
Keywords:Abnormalities, Multiple, Female, Gestational Age, Hernias, Diaphragmatic, Congenital, Humans, Hypertension, Pulmonary, Infant, Newborn, Lung, Lung Diseases, Lung Volume Measurements, Pregnancy, Pregnancy Outcome, Prenatal Diagnosis, Prospective Studies, Ultrasonography, Prenatal
  • WoS Id: 000348972200004
  • DOI: https://doi.org/10.1159/000364805
  • Scopus Id: 84922402578
  • ORCID: /0000-0002-6856-7025/work/60549735
  • ORCID: /0000-0003-2635-7297/work/76617536