Document Detail


Usefulness of lung-to-head ratio and intrapulmonary Doppler in predicting neonatal morbidity in fetuses with congenital diaphragmatic hernia treated with fetoscopic tracheal occlusion.
MedLine Citation:
PMID:  22689226     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Objective: To explore the potential value of intrapulmonary Doppler in predicting neonatal morbidity in fetuses with left-sided congenital diaphragmatic hernia (CDH) treated with fetoscopic tracheal occlusion (FETO). Methods: Observed/expected lung to head ratio (O/E LHR) and intrapulmonary Doppler Pulsatility Index (PI) and Peak Early Diastolic Reverse Flow (PEDRF) were evaluated within 24 hours before FETO in a consecutive cohort of 51 left-sided CDH fetuses between 24 to 33 weeks of gestation. Lung Doppler parameters were converted into z-scores and defined as abnormal as either PI > 1.0 z-score and PEDRF > 3.5 z-scores. The association of O/E LHR and Doppler with neonatal outcome was assessed using multiple linear or logistic regression adjusted by gestational age at birth. Results: Among the 26 fetuses who survived, 18 (69.2%) had normal and 8 (30.8%) abnormal Doppler values. O/E LHR was not associated with neonatal morbidity in surviving fetuses. As compared with the group with normal Doppler, abnormal intrapulmonary Doppler was associated with a significant increase in the duration of mechanical ventilation (average increase of 21.2 days, 95% CI 9.99-32.5, p<0.01), conventional ventilation (15.2 days, 95% CI 7.43-23.0, p<0.01), high frequency ventilation (6.34 days, 95% CI 0.69-11.99, p<0.05), nitric oxide therapy (5.73 days, 95% CI 0.60-10.9, p<0.05), need of oxygen support (36.5 days, 95% CI 16.3-56.7, p<0.01), parenteral nutrition (19.1 days, 95% CI 7.53-30.7, p<0.01) and stay at neonatal intensive care unit (42.7 days, 95% CI 22.9-62.6, p<0.001), and with a significantly higher rate of high frequency ventilation (87.5% vs. 44.4%, p<0.05), oxygen requirement at 28 days of neonatal age (75.0% vs. 11.1%, p<0.01), gastroesophageal reflux (62.5% vs. 22.2%, p<0.05) and tube feeding at discharge (37.5% vs. 5.56%, p<0.05). Conclusion: As previously reported, O/E LHR did not predict neonatal morbidity. In contrast, intrapulmonary Doppler evaluation was predictive of neonatal morbidity in CDH fetuses treated with FETO. Copyright © 2012 ISUOG. Published by John Wiley & Sons, Ltd.
Authors:
Rogelio Cruz-Martinez; Montserrat Castañon; Oscar Moreno-Alvarez; Ruthy Acosta-Rojas; Josep M Martinez; Eduard Gratacos
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-6-11
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:  -     Publication Date:  2012 Jun 
Date Detail:
Created Date:  2012-6-12     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 © 2012 ISUOG. Published by John Wiley & Sons, Ltd.
Affiliation:
Department of Maternal-Fetal Medicine, Institute Clínic of Gynecology, Obstetrics and Neonatology, Hospital Clinic-IDIBAPS, University of Barcelona and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain.
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