Stomach position in prediction of survival in left‐sided congenital diaphragmatic hernia with or without fetoscopic endoluminal tracheal occlusion

Objective: To report on our experience in the prenatal treatment of severe congenital diaphragmatic hernia (CDH) by fetoscopic endoluminal tracheal occlusion (FETO). Methods: Between 2012 and 2014, FETO was performed at our center in 21 cases of CDH considered to be severe based on sonographic measurement of observed/expected lung-to-head ratio (O/E LHR) and side of the defect. We reported pre- and postoperative ultrasound findings, procedure-related complications, pregnancy outcome and survival at 1-3 years of age. Results: The median gestational age (GA) at balloon insertion was 28.1 weeks (range 26.0-31.1) and the median GA at delivery 34.7 weeks (range 31.6-39.0); delivery before 32 and 34 weeks occurred in 2 (9.5%) and 7 (33.3%) cases, respectively. Postnatal survival at 1-3 years of age in the 17 cases with isolated unilateral CDH was 47.1%. The percentage difference between pre-balloon removal O/E LHR and pre-FETO O/E LHR was significantly higher in survivors compared to neonates who died (40.8 vs. 21.2%, respectively; p < 0.05). Conclusions: In this study, FETO was associated with an infant survival of 47% in cases with isolated unilateral severe CDH. The post-FETO increase in O/E LHR was higher in fetuses that survived compared to those who died.

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“…Data from a proportion of cases presented in this study were reported in two previous collaborative studies [8,9] .…”

Section: Methodsmentioning

confidence: 99%

Fetoscopic Endoluminal Tracheal Occlusion in Fetuses with Severe Diaphragmatic Hernia: A Three-Year Single-Center Experience

et al. 2016

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“…However, their proposed algorithm requires particular expertise in fetal evaluation of left CDH: the determination of liver position and judgment as to the degree of abnormality of the herniated stomach [12, 25, 26]. Cordier and colleagues recently demonstrated that fetal stomach position was predictive of postnatal survival and need for prosthetic patch repair of the diaphragm defect [21]. However, to our knowledge, the relationship between fetal stomach position, neonatal extracorporeal membrane oxygenation (ECMO) requirement, and short-term respiratory morbidity has not yet been reported.…”

Section: Introductionmentioning

confidence: 99%

Fetal Stomach Position Predicts Neonatal Outcomes in Isolated Left-Sided Congenital Diaphragmatic Hernia

et al. 2015

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Introduction: We sought to determine the relationship between the degree of stomach herniation by antenatal sonography and neonatal outcomes in fetuses with isolated left-sided congenital diaphragmatic hernia (CDH). Materials and Methods: We retrospectively reviewed neonatal medical records and antenatal sonography of fetuses with isolated left CDH cared for at a single institution (2000-2012). Fetal stomach position was classified on sonography as follows: intra-abdominal, anterior left chest, mid-to-posterior left chest, or retrocardiac (right chest). Results: Ninety fetuses were included with 70% surviving to neonatal discharge. Stomach position was intra-abdominal in 14% (n = 13), anterior left chest in 19% (n = 17), mid-to-posterior left chest in 41% (n = 37), and retrocardiac in 26% (n = 23). Increasingly abnormal stomach position was linearly associated with an increased odds of death (OR 4.8, 95% CI 2.1-10.9), extracorporeal membrane oxygenation (ECMO; OR 5.6, 95% CI 1.9-16.7), nonprimary diaphragmatic repair (OR 2.7, 95% CI 1.4-5.5), prolonged mechanical ventilation (OR 5.9, 95% CI 2.3-15.6), and prolonged respiratory support (OR 4.0, 95% CI 1.6-9.9).All fetuses with intra-abdominal stomach position survived without substantial respiratory morbidity or need for ECMO. Discussion: Fetal stomach position is strongly associated with neonatal outcomes in isolated left CDH. This objective tool may allow for accurate prognostication in a variety of clinical settings.

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“…The intra-abdominal fetal stomach position is associated with a more favorable prognosis, whereas the presence of the stomach within the thorax during the fetal or neonatal period has been shown in multiple studies to correlate with an adverse outcome. Recently, Cordier et al have confirmed that fetal stomach position was predictive of postnatal survival and the need for patch repair [25]. According to some papers, there might be a strong association between neonatal death, ECMO (extracorporeal membrane oxygenation) requirement and short-term respiratory morbidity, depending on the position of the fetal stomach [24].…”

Section: Prognostic Factorsmentioning

confidence: 95%

Congenital diaphragmatic hernia: pathogenesis, prenatal diagnosis and management — literature review

Kosiński

Wielgoś

2017

Ginekol Pol

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Congenital diaphragmatic hernia (CDH) is a developmental discontinuity of the diaphragm. It allows abdominal viscera to herniate into the chest and leads to lung hypoplasia. Congenital diaphragmatic hernia is one of the most severe birth defects, with extremely high neonatal mortality. This paper presents a review of the available literature on prenatal diagnosis, management and treatment options for CDH. In selected cases, a prenatal procedure to improve neonatal survival is possible. The authors of this manuscript believe their work might contribute to a better understanding of congenital diaphragmatic hernia and patient selection for the FETO (fetal endoscopic tracheal occlusion) surgery or expectant management.

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Stomach position in prediction of survival in left‐sided congenital diaphragmatic hernia with or without fetoscopic endoluminal tracheal occlusion

Abstract: Objective To investigate the value of fetal stomach position in predicting postnatal outcome in left-sided congenital diaphragmatic hernia (CDH) with and without fetoscopic endoluminal tracheal occlusion (FETO). Methods

Cited by 65 publications

References 35 publications

Fetoscopic Endoluminal Tracheal Occlusion in Fetuses with Severe Diaphragmatic Hernia: A Three-Year Single-Center Experience

Fetoscopic Endoluminal Tracheal Occlusion in Fetuses with Severe Diaphragmatic Hernia: A Three-Year Single-Center Experience

Fetal Stomach Position Predicts Neonatal Outcomes in Isolated Left-Sided Congenital Diaphragmatic Hernia

Congenital diaphragmatic hernia: pathogenesis, prenatal diagnosis and management — literature review

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