Kamal Ali1, Perraju Bendapudi1, Satyamaanasa Polubothu1, Gwendolyn Andradi2, Mercy Ofuya3, Janet Peacock3,4, Ann Hickey1, Mark Davenport5, Kypros Nicolaides6, Anne Greenough7,8,9. 1. Neonatal Intensive Care Unit, King's College Hospital, 4th Floor Golden Jubilee Wing, Denmark Hill, London, SE5 9RS, UK. 2. Division of Asthma, Allergy and Lung Biology, MRC and Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, London, UK. 3. Division of Health and Social Care Research, Faculty of Life Sciences and Medicine, King's College London, London, UK. 4. NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK. 5. Department of Paediatric Surgery, King's College Hospital, London, UK. 6. Department of Fetal Medicine, King's College Hospital, London, UK. 7. Neonatal Intensive Care Unit, King's College Hospital, 4th Floor Golden Jubilee Wing, Denmark Hill, London, SE5 9RS, UK. anne.greenough@kcl.ac.uk. 8. Division of Asthma, Allergy and Lung Biology, MRC and Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, London, UK. anne.greenough@kcl.ac.uk. 9. NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK. anne.greenough@kcl.ac.uk.
Abstract
UNLABELLED: The morbidity of infants with congenital diaphragmatic hernia (CDH) who had undergone foetal endoscopic tracheal occlusion (FETO) to those who had not was compared and predictors of survival regardless of antenatal intervention were identified. FETO was undertaken on the basis of the lung to head ratio or the position of the liver. A retrospective review of the records of 78 CDH infants was undertaken to determine the lung-head ratio (LHR) at referral and prior to birth, maximum oxygen saturation in the labour suite and neonatal outcomes. The 43 FETO infants were born earlier (mean 34 versus 38 weeks) (p < 0.001). They had a lower mean LHR at referral (0.65 versus 1.24) (p < 0.001) but not prior to birth and did not have a higher mortality than the 35 non-FETO infants. The FETO infants required significantly longer durations of ventilation (median: 15 versus 6 days) and supplementary oxygen (28 versus 8 days) and hospital stay (29 versus 16 days). Overall, the best predictor of survival was the OI in the first 24 h. CONCLUSION: The FETO group had increased morbidity, but not mortality. The lowest oxygenation index in the first 24 h was the best predictor of survival regardless of antenatal intervention. WHAT IS KNOWN: • Randomised controlled trials have demonstrated that foetal endotracheal occlusion (FETO) in high risk infants with congenital diaphragmatic hernia is associated with a higher survival rate. • Mortality is greater in foetuses who underwent FETO and delivered prior to 35 weeks of gestation. What is New: • Infants who had undergone FETO compared to those who had not had significantly longer durations of mechanical ventilation, supplementary oxygen and hospital stay. • Regardless of antenatal intervention, the lowest oxygenation index in the first 24 h was the best predictor of survival.
UNLABELLED: The morbidity of infants with congenital diaphragmatic hernia (CDH) who had undergone foetal endoscopic tracheal occlusion (FETO) to those who had not was compared and predictors of survival regardless of antenatal intervention were identified. FETO was undertaken on the basis of the lung to head ratio or the position of the liver. A retrospective review of the records of 78 CDH infants was undertaken to determine the lung-head ratio (LHR) at referral and prior to birth, maximum oxygen saturation in the labour suite and neonatal outcomes. The 43 FETO infants were born earlier (mean 34 versus 38 weeks) (p < 0.001). They had a lower mean LHR at referral (0.65 versus 1.24) (p < 0.001) but not prior to birth and did not have a higher mortality than the 35 non-FETO infants. The FETO infants required significantly longer durations of ventilation (median: 15 versus 6 days) and supplementary oxygen (28 versus 8 days) and hospital stay (29 versus 16 days). Overall, the best predictor of survival was the OI in the first 24 h. CONCLUSION: The FETO group had increased morbidity, but not mortality. The lowest oxygenation index in the first 24 h was the best predictor of survival regardless of antenatal intervention. WHAT IS KNOWN: • Randomised controlled trials have demonstrated that foetal endotracheal occlusion (FETO) in high risk infants with congenital diaphragmatic hernia is associated with a higher survival rate. • Mortality is greater in foetuses who underwent FETO and delivered prior to 35 weeks of gestation. What is New: • Infants who had undergone FETO compared to those who had not had significantly longer durations of mechanical ventilation, supplementary oxygen and hospital stay. • Regardless of antenatal intervention, the lowest oxygenation index in the first 24 h was the best predictor of survival.
Entities:
Keywords:
Congenital diaphragmatic hernia; FETO; Oxygenation index; Prediction of mortality
Authors: Jacques C Jani; Kypros H Nicolaides; Eduardo Gratacós; Hilde Vandecruys; Jan A Deprest Journal: Am J Obstet Gynecol Date: 2006-06-12 Impact factor: 8.661
Authors: J C Jani; K H Nicolaides; E Gratacós; C M Valencia; E Doné; J-M Martinez; L Gucciardo; R Cruz; J A Deprest Journal: Ultrasound Obstet Gynecol Date: 2009-09 Impact factor: 7.299
Authors: Juan E Sola; Steven N Bronson; Michael C Cheung; Beatriz Ordonez; Holly L Neville; Leonidas G Koniaris Journal: J Pediatr Surg Date: 2010-06 Impact factor: 2.545
Authors: E Doné; E Gratacos; K H Nicolaides; K Allegaert; C Valencia; M Castañon; J-M Martinez; J Jani; T Van Mieghem; A Greenough; O Gomez; P Lewi; J Deprest Journal: Ultrasound Obstet Gynecol Date: 2013-07 Impact factor: 7.299
Authors: Tim Jancelewicz; Lan T Vu; Roberta L Keller; Barbara Bratton; Hanmin Lee; Diana Farmer; Michael Harrison; Doug Miniati; Tippi Mackenzie; Shinjiro Hirose; Kerilyn Nobuhara Journal: J Pediatr Surg Date: 2010-01 Impact factor: 2.545
Authors: Abigail Wilpers; Anna Y Lynn; Barbara Eichhorn; Amy B Powne; Megan Lagueux; Janene Batten; Mert Ozan Bahtiyar; Cary P Gross Journal: Fetal Diagn Ther Date: 2022-03-10 Impact factor: 2.208