Document Detail


Early fetoscopic tracheal occlusion for extremely severe pulmonary hypoplasia in human isolated congenital diaphragmatic hernia: preliminary results.
MedLine Citation:
PMID:  23349059     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
OBJECTIVE: To evaluate the effect of early fetoscopic tracheal occlusion (22-24 weeks) on pulmonary response and neonatal survival in extremely severe isolated CDH. METHODS: Multicenter study involving fetuses with extremely severe CDH (lung-to-head ratio <0.70, liver herniation into the thoracic cavity, no other detectable anomalies). Between August 2010 and December 2011, eight fetuses had early FETO. Data were compared with 9 fetuses that had standard FETO and 10 cases without fetal procedure from January 2006 to July 2010. FETO was performed under maternal epidural anesthesia supplemented with fetal intramuscular anesthesia. Fetal lung size and vascularity were evaluated before and every 2 weeks after FETO by means ultrasounds. Postnatal therapy was equivalent for both treated fetuses and controls. Primary outcome was infant survival to 180 days and second outcome was fetal pulmonary response. RESULTS: Maternal and fetal demographic characteristics, and obstetric complications, were similar in the three groups (p>0.05). The infant survival rate was significantly higher in the early FETO group (57.1%) compared to standard FETO (11.1%) and controls (0%) (p=0.02). Early FETO resulted in a significant improvement in fetal lung size and pulmonary vascularity when compared to standard FETO (p<0.01). CONCLUSIONS: Early FETO may improve infant survival by further increases of lung size and pulmonary vascularity in cases with extremely severe pulmonary hypoplasia in human isolated CDH. This study supports formal testing of the hypothesis with a randomized controlled trial.
Authors:
Rodrigo Ruano; Jose Luis Peiro; Marcos Marques da Silva; Duarte Bonini Campos Juliana Alvares; Carreras Elena; Tannuri Uenis; Zugaib Marcelo
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-1-24
Journal Detail:
Title:  Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology     Volume:  -     ISSN:  1469-0705     ISO Abbreviation:  Ultrasound Obstet Gynecol     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2013-1-25     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9108340     Medline TA:  Ultrasound Obstet Gynecol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2013 ISUOG. Published by John Wiley & Sons, Ltd.
Affiliation:
Obstetrics Department, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil; Texas Children's Hospital Fetal Center and the Department of Obstetics and Gynecology, Baylor College of Medicine, Houston, Texas, USA.
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