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J Pediatr Surg. 2013 Sep;48(9):1831-6. doi: 10.1016/j.jpedsurg.2013.01.049.

Outcome of CDH infants following fetoscopic tracheal occlusion - influence of premature delivery.

Author information

1
Division of Asthma, Allergy and Lung Biology, MRC and Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, United Kingdom.

Abstract

PURPOSE:

To evaluate the mortality and morbidity of infants with congenital diaphragmatic hernia who had undergone fetal endoscopic tracheal occlusion (FETO) and whether this was influenced by premature birth.

METHODS:

The gestational age at delivery, lung-head ratio (LHR) pre and post FETO, neonatal outcomes, and respiratory, gastro-intestinal, neurological, surgical, and musculoskeletal problems at follow up of consecutive infants who had undergone FETO were determined. Elective reversal of FETO was planned at 34 weeks of gestation.

RESULTS:

The survival rate of the 61 FETO infants was 48%, with 84% delivered prematurely. Thirty-one delivered <35 weeks of gestation. Their survival rate was 18%. Twenty-three of 24 infants who had emergency balloon removal were born <35 weeks of gestation. Survival was related to gestational age at delivery (OR 0.55, 95% CI 0.420, 0.77, p<0.001) and the duration of FETO (OR 0.73, 95% CI 0.59, 0.91, p<0.005). Infants born prior to 35 weeks of gestation compared to those born at ≥ 35 weeks required a longer duration of ventilation (median 45 days versus 12 days, p<0.001), and a greater proportion had surgery for gastro-oesophageal reflux (50% versus 9%, p=0.011).

CONCLUSION:

These results emphasize the need to reduce premature delivery following FETO.

KEYWORDS:

Congenital diaphragmatic hernia; Fetal endoscopic occlusion of trachea; Prematurity

PMID:
24074653
DOI:
10.1016/j.jpedsurg.2013.01.049
[Indexed for MEDLINE]

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