Could the stomach site help predict outcome in babies with left sided congenital diaphragmatic hernia diagnosed antenatally?

Burge, D.M.; Atwell, J. D.; Freeman, N.V.

doi:10.1016/s0022-3468(89)80507-x

Cited by 77 publications

(34 citation statements)

References 6 publications

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“…Antenatal diagnosis before 25 weeks of gestational age [57], associated malformations [58], intrathoracic position of the stomach [59] and left heart hypoplasia are predictors of poor outcome [60]. Antenatal ultrasound prediction of pulmonary hypoplasia is difficult because the lung is not easy to distinguish from the gut.…”

Section: Prenatal Diagnosismentioning

confidence: 99%

Congenital Diaphragmatic Hernia

1998

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Congenital diaphragmatic hernia (CDH) is still an unsolved problem. A disease which was, for a long time, thought to be merely a hole in the diaphragm appears today to be an intriguing malformation with a poorly understood pathogenesis and a complex pathophysiology. CDH results in various degrees of pulmonary hypoplasia and severe persistent pulmonary hypertension of the newborn. Despite antenatal ultrasound diagnosis and continuous improvement in neonatal intensive care, these features could not be overcome, and the overall mortality rate in CDH is still reaching 50%. Experimental works during the past 20 years suggest that CDH is a disease of impaired lung development associated with, but not caused by, a structural defect of the diaphragm. Furthermore, there is increasing evidence that the lung in CDH is not only small but that there are numerous disorders (e.g. surfactant deficiency, decreased anti-oxidant activity, increased vascular reactivity with decreased nitric oxide and increased endothelin 1 activity, and left heart hypoplasia) which may be associated with impaired lung development. Although antenatal diagnosis of CDH is feasible by ultrasound, there is no reliable predictor of pulmonary hypoplasia, the main prognostic factor in CDH. Whilst modern therapeutic strategies such as high-frequency oscillatory ventilation, exogenous surfactant or inhaled nitric oxide may be beneficial in selected subjects, most newborns with hypoplastic lungs will not survive despite these postnatal therapies. Perhaps these newborns would benefit from antenatal treatment directed at altering lung growth early in utero to minimize pulmonary hypoplasia. Therefore, research is needed to elucidate the aetiology and pathogenesis of CDH. Knowledge about the cellular control of proliferation, differentiation and programmed cell death (apoptosis) in the organogenesis should clarify our understanding of these processes and allow us to develop drugs that stimulate lung growth or even correct the anatomical defect. Furthermore, early and reliable assessment of prognosis for fetuses with CDH at risk of death will become increasingly important in the identification of fetuses most likely to benefit from antenatal therapies and may eventually lead to decreased mortality.

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Section: Prenatal Diagnosismentioning

confidence: 99%

Congenital Diaphragmatic Hernia

1998

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“…Reports of fetuses with mortalities greater than 60-70% include those detected before 25 weeks of gestation [9,29,30], those with car diac ventricular disproportion [29,31,32], those with a small lung to thoracic area ratio [33], those with a large distended stomach in the chest [9,34,35], and those with a large volume of liver in the chest [5,6,27,[29][30][31][32][33][34][35]. None of the attempts at discrimination have been entirely successful.…”

Section: Fetal Selectionmentioning

confidence: 99%

“…Initially cardiac ventricular disproportion seen before 24 weeks of gestation appeared to correlate with a mortality of 100% [31,32], With further cases, however, there were 2 sur vivors picked up before 24 weeks with the same cardiac ventricular disproportion [29] that had previously indicated a poor outcome, leaving an 84% mortality for fetuses with a CDH and an abnormally low LV/RV ratio [29]. Gestational age appeared to make little difference but progressive deterioration of the left ventricular development was more pre dictive of a poor outcome [29].…”

Section: Cardiac Ventricular Disproportion and Gestational Agementioning

confidence: 99%

“…Large cystic adenoma toid malformations of the lung can increase in size to produce mediastinal shift, polyhy dramnios and fetal hydrops [52], similar to the effects of CDH. If the cystic adenomatoid malformation is removed antenatally, or after birth, the residual lung will recover [53,54], When there is fetal cardiomegaly before 19 weeks of gestation, then there is also pulmo nary hypoplasia [55,56], In addition, the pressure of the viscera appears to compress the heart and cause left ventricular hypoplasia with a left-sided CDH, and right ventricular hypoplasia with a right-sided CDH [29], This ventricular hypoplasia is reversible [31], implying that this part of the complex is not a field defect [57].…”

Section: Evidence Against a Field Defectmentioning

confidence: 99%

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Fetal Intervention for Congenital Diaphragmatic Hernia

Ford

1994

Fetal Diagn Ther

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Despite improvements in surgical techniques, the results of open fetal surgery to correct congenital diaphragmatic hernia have been disappointing. Hysterotomy induces preterm labour and, where there is a large volume of liver in the fetal chest, reduction of the liver into the abdomen induces immediate fetal death. Less invasive techniques, using both open surgery and fetoscopy, are being developed in the hope of reducing fetal demise. These techniques include blocking the trachea, the creation of an artificial gastroschisis and induction of graft tolerance for postnatal lung transplantation.

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“…1 Over the years, many predictors of outcome have been suggested. Sonographic parameters of the fetus have included early diagnosis, 2 polyhydramnios, 2 intrathoracic stomach, 3 mediastinal shift, visceral herniation, 4 and quantification of the contralateral lung area. 5 A very promising prognostic indicator, that of ''liverup'' vs ''liver-down'', predicted 75 to 80% survival in the ''liverdown'' group.…”

Section: Introductionmentioning

confidence: 99%

Heart Rate Variability as an Indicator of Outcome in Congenital Diaphragmatic Hernia With and Without ECMO Support

Verklan

Padhye

2004

J Perinatol

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OBJECTIVE:To examine differences in the spectral power content in neonates diagnosed with congenital diaphragmatic hernia (CDH) who survive or succumb. STUDY DESIGN:A case-series study design evaluated four neonates diagnosed with CDH, two of which were supported by extracorporeal membrane oxygenation (ECMO). The electrocardiogram signal was digitized at 1000 Hz and the Lomb periodogram was computed for the series of interbeat intervals. RESULTS:Neonates with CDH who survived had log total power values greater than 2. Those with CDH who did not survive had log total power less than 2, but generally exceeded 3 while they were supported by ECMO. CONCLUSIONS:Neonates who consistently displayed increasing total spectral energies had a better outcome than those whose spectral energies were low. Subjects who succumbed expressed the lowest values, suggesting that a frequencybased evaluation of HRV may be a sensitive prognosticator of outcome that requires further investigation.

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Could the stomach site help predict outcome in babies with left sided congenital diaphragmatic hernia diagnosed antenatally?

Cited by 77 publications

References 6 publications

Congenital Diaphragmatic Hernia

Congenital Diaphragmatic Hernia

Fetal Intervention for Congenital Diaphragmatic Hernia

Heart Rate Variability as an Indicator of Outcome in Congenital Diaphragmatic Hernia With and Without ECMO Support

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