Prenatal prediction of lethal pulmonary hypoplasia: The hyperoxygenation test for pulmonary artery reactivity

Broth, Richard; Wood, Dennis; Räsänen, Juha; Sabogal, Juan Carlos; Komwilaisak, Ratana; Weiner, Stuart; Berghella, Vincenzo

doi:10.1067/mob.2002.127130

Cited by 91 publications

(63 citation statements)

References 20 publications

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“…Infants not responding to iNO had significantly lower birth weight and higher mortality. Broth et al 22 used the hyperoxygenation test for pulmonary artery reactivity to predict which fetuses would be at risk for lethal pulmonary hypoplasia. A nonreactive hyperoxygenation test (defined as <20% decrease in pulsatility index of either branch pulmonary artery) predicted 79% of deaths caused by pulmonary hypoplasia.…”

Section: Discussionmentioning

confidence: 99%

Characteristics of pulmonary hypertension in preterm neonates

et al. 2007

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Objective: Characteristics of preterm infants who develop pulmonary hypertension (PHT) and their response to inhaled nitric oxide (iNO) are not well described. Our objective was to identify risk factors for PHT in infants <37 weeks gestational age (GA) and to evaluate their response to iNO.Study design: A retrospective chart review was conducted in infants <37 weeks GA born from July/2000 to October/2005 who had an echocardiographic diagnosis of PHT in the first 4 weeks of life. A comparison non-PHT group was generated matched for GA and birth date. Data on prenatal and postnatal characteristics, response to iNO and mortality were collected.Results: Low Apgar scores, preterm premature rupture of membranes, oligohydramnios, pulmonary hypoplasia and sepsis were independently predictive of PHT. Mortality was significantly higher in the PHT group (26.2% versus 4.1%; P<0.0001) compared to the control group. Low birth weight, severe intraventricular hemorrhage and male sex were significantly associated with death in infants with PHT. Thirty-seven percent (23/61) of infants with PHT were treated with inhaled NO. Infants <29-week GA had poor response to iNO and the response to iNO increased with GA (P<0.02).Conclusions: Low Apgar scores, oligohydramnios and pulmonary hypoplasia are associated with the development of PHT in premature infants. The percentage of infants responding to iNO increases with advancing GA.

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Section: Discussionmentioning

confidence: 99%

Characteristics of pulmonary hypertension in preterm neonates

et al. 2007

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“…In our practice, we focus on measurement of the PA reactivity with maternal hyperoxygenation. This mimics changes in fetal hemodynamics as they occur after birth (Broth et al, 2002). This hyperoxygenation test involves Doppler measurements of the pulsatility index (PI) in the first branch of the contralateral PA, before and after maternal administration of 60% O 2 by mask.…”

Section: Prediction Of Pulmonary Arterial Hypertension (Pah)mentioning

confidence: 99%

Prenatal diagnosis, prediction of outcome and in utero therapy of isolated congenital diaphragmatic hernia

et al. 2008

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Congenital diaphragmatic hernia (CDH) can be associated with genetic or structural anomalies with poor prognosis. In isolated cases, survival is dependent on the degree of lung hypoplasia and liver position. Cases should be referred in utero to tertiary care centers familiar with this condition both for prediction of outcome as well as timed delivery. The best validated prognostic indicator is the lung area to head circumference ratio. Ultrasound is used to measure the lung area of the index case, which is then expressed as a proportion of what is expected normally (observed/expected LHR). When O/E LHR is <25% survival chances are <15%. Prenatal intervention, aiming to stimulate lung growth, can be achieved by temporary fetal endoscopic tracheal occlusion (FETO). A balloon is percutaneously inserted into the trachea at 26-28 weeks, and reversal of occlusion is planned at 34 weeks. Growing experience has demonstrated the feasibility and safety of the technique with a survival rate of about 50%. The lung response to, and outcome after FETO, is dependent on pre-existing lung size as well gestational age at birth. Early data show that FETO does not increase morbidity in survivors, when compared to historical controls. Several trials are currently under design.

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“…The following variables were recorded in the prenatal period: side of the hernia (left/right/bilateral), presence or absence of liver herniation, lung size and pulmonary reactivity test [46], all assessed at around 26-28 weeks (further referred to as late second trimester or time point 1), and at around 34 weeks (further referred to as mid-third trimester or time point 2). In those fetuses that underwent FETO, measurements were done after balloon removal.…”

Section: Methodsmentioning

confidence: 99%

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

Doné¹,

Debeer

Gucciardo³

et al. 2014

Fetal Diagn Ther

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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.

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Prenatal prediction of lethal pulmonary hypoplasia: The hyperoxygenation test for pulmonary artery reactivity

Cited by 91 publications

References 20 publications

Characteristics of pulmonary hypertension in preterm neonates

Characteristics of pulmonary hypertension in preterm neonates

Prenatal diagnosis, prediction of outcome and in utero therapy of isolated congenital diaphragmatic hernia

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

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