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Ultrasound Obstet Gynecol. 2019 Jan 14. doi: 10.1002/uog.20216. [Epub ahead of print]

Fetal endoscopic tracheal occlusion reduces pulmonary hypertension in severe congenital diaphragmatic hernia.

Author information

1
Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX.
2
Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX.
3
Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX.
4
Department of Pediatrics - Cardiology Section, Baylor College of Medicine, Houston, TX.
5
Department of Anesthesiology, Baylor College of Medicine, Houston, TX.
6
Newborn Section, Baylor College of Medicine, Houston, TX.

Abstract

OBJECTIVE:

Fetal endoscopic tracheal occlusion (FETO) is associated with increased perinatal survival and reduced need for Extracorporeal Membrane Oxygenation (ECMO) among fetuses with severe congenital diaphragmatic hernia (CDH). This study evaluates the impact of FETO on the resolution of pulmonary hypertension (PH) in fetuses with isolated CDH.

METHODS:

All fetuses evaluated for CDH between January 2004 and July 2017 at a single institution were included. CDH cases were retrospectively reclassified by prenatal MRI severity indices, (observed to expected total lung volume and percent liver herniation) into mild, moderate, and severe groups. Postnatal echocardiograms were used to determine presence of PH. Logistic regression analyses were performed to determine the relationship between FETO with resolution of PH by 1 year of life while controlling for site of the CDH, use of ECMO, gestational age (GA) at diagnosis, GA at delivery, fetal gender, sildenafil use at discharge and CDH severity. Resolution of PH by 1 year of life was compared in a cohort of fetuses with severe CDH who underwent FETO to that of a non-FETO cohort. A sub-analysis was performed restricting the analysis to isolated left CDH. Parametric and non-parametric tests were used for comparisons; p<0.05 was considered significant.

RESULTS:

A total of 256 CDH cases were evaluated; 72% (n=184) had no major structural or chromosomal anomalies and 58% (n=107) of them met study inclusion criteria. The FETO cohort consisted of 19 CDH cases and the 88 non-FETO cohort consisted of 35% mild (n=31), 36% moderate (n=32), 29% severe (n=25) CDH cases. All infants with severe CDH, with and without FETO, had evidence of neonatal PH. FETO (OR: 3.57; 95% CI: 1.05-12.102; p=0.041) and ECMO (OR=5.01, 95% CI: 2.1 - 11.9; p<0.001) were independent predictors of resolution of PH by 1 year of age. A higher proportion of infants with severe CDH who underwent FETO had resolution of PH compared to infants with severe CDH in the non-FETO cohort [69% (11/16) vs. 28% (7/25); p: 0.017). Similar results were observed when the analysis was restricted to left CDH cases only [PH resolution in 69% (11/16) vs. 28% (5/18); p=0.032] CONCLUSIONS: In severe CDH infants, FETO and ECMO are independently associated with increased resolution of PH by 1 year of life. This article is protected by copyright. All rights reserved.

KEYWORDS:

congenital; diaphragmatic; fetoscopic; hernia; hypertension; occlusion; pulmonary; tracheal

PMID:
30640410
DOI:
10.1002/uog.20216

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