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

Done, Elisa; Debeer, Anne; Gucciardo, Leonardo; Van Mieghem, Tim; Lewi, Paul; Devlieger, Roland; De Catte, Luc; Lewi, Liesbeth; Allegaert, Karel; Deprest, Jan

doi:10.1159/000364805

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

Author:

Done, Elisa

Debeer, Anne ; Gucciardo, Leonardo ; Van Mieghem, Tim ; Lewi, Paul ; Devlieger, Roland ; De Catte, Luc ; Lewi, Liesbeth ; Allegaert, Karel ; Deprest, Jan

Keywords:

Science & Technology, Life Sciences & Biomedicine, Obstetrics & Gynecology, Congenital diaphragmatic hernia, Fetoscopy, Neonatal outcome, Pulmonary hypoplasia, Ultrasound, Pulmonary hypertension, FETOSCOPIC TRACHEAL OCCLUSION, TO-HEAD RATIO, MAGNETIC-RESONANCE, LUNG-VOLUME, PRENATAL PREDICTION, POSTNATAL MANAGEMENT, 12-YEAR EXPERIENCE, LIVER HERNIATION, CONTROLLED-TRIAL, SURVIVAL RATE, 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, 1114 Paediatrics and Reproductive Medicine, Obstetrics & Reproductive Medicine, 3213 Paediatrics, 3215 Reproductive medicine

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. © 2014 S. Karger AG, Basel.