F M Russo1,2, M P Eastwood1, R Keijzer3, J Al-Maary3, J Toelen1,4, T Van Mieghem1,2, J A Deprest1,2,5. 1. Academic Department of Development and Regeneration, Organ Systems Cluster, KU Leuven, Leuven, Belgium. 2. Clinical Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium. 3. Departments of Surgery, Pediatrics & Child Health and Physiology, University of Manitoba, and Children's Hospital Research Institute of Manitoba, Biology of Breathing, Winnipeg, Manitoba, Canada. 4. Clinical Department of Pediatrics, University Hospitals Leuven, Leuven, Belgium. 5. Institute of Women's Health, University College London Hospitals, London, UK.
Abstract
OBJECTIVES: To identify antenatal predictors of persistent pulmonary hypertension (PPH) and the need for extracorporeal membrane oxygenation (ECMO) in fetuses with congenital diaphragmatic hernia (CDH). METHODS: We performed a systematic literature review on antenatal diagnostic tests in fetuses with isolated CDH. The primary outcomes assessed were PPH within 28 days of age and the need for ECMO. Quality of studies was assessed with the QUADAS-2 tool. Meta-analysis was performed when at least three studies reported on the same test. Sensitivity analysis was performed according to prenatal management of CDH (tracheal occlusion vs expectant management). RESULTS: Thirty-eight studies met the inclusion criteria. Fifteen reported on the incidence of PPH only, 19 on the need for ECMO only and four reported on both outcomes. The general quality of the studies was moderate; most studies were retrospective (61%) and single-center series (92%). One study included only fetuses undergoing tracheal occlusion, 22 included only fetuses managed expectantly in utero and 15 included both populations. We could not identify antenatal predictors of PPH. The need for ECMO was predicted by parameters indicative of lung size: lung-to-head ratio (LHR) (relative risk (RR) for LHR < 1, 1.65 (95% CI, 1.27-2.14)) and observed/expected LHR (standardized mean difference (SMD), -0.70 (95% CI, -0.98 to -0.42)) measured by ultrasound and observed/expected total lung volume (SMD, -1.00 (95% CI, -1.52 to -0.48)) measured by magnetic resonance imaging. Liver herniation was also associated with an increased risk of need for ECMO (RR, 3.04 (95% CI, 2.23-4.14)). These results were confirmed by a sensitivity analysis of studies that included only expectantly managed cases. Data on vascular assessment for the prediction of PPH could not be pooled as most of the parameters were evaluated in a single series or in different series by the same principal investigator. CONCLUSIONS: In fetuses with CDH, lung size and liver herniation predict the need for ECMO, however a predictor for PPH is still lacking. Further studies aimed at diagnosing impaired vascular development in utero should therefore be undertaken.
OBJECTIVES: To identify antenatal predictors of persistent pulmonary hypertension (PPH) and the need for extracorporeal membrane oxygenation (ECMO) in fetuses with congenital diaphragmatic hernia (CDH). METHODS: We performed a systematic literature review on antenatal diagnostic tests in fetuses with isolated CDH. The primary outcomes assessed were PPH within 28 days of age and the need for ECMO. Quality of studies was assessed with the QUADAS-2 tool. Meta-analysis was performed when at least three studies reported on the same test. Sensitivity analysis was performed according to prenatal management of CDH (tracheal occlusion vs expectant management). RESULTS: Thirty-eight studies met the inclusion criteria. Fifteen reported on the incidence of PPH only, 19 on the need for ECMO only and four reported on both outcomes. The general quality of the studies was moderate; most studies were retrospective (61%) and single-center series (92%). One study included only fetuses undergoing tracheal occlusion, 22 included only fetuses managed expectantly in utero and 15 included both populations. We could not identify antenatal predictors of PPH. The need for ECMO was predicted by parameters indicative of lung size: lung-to-head ratio (LHR) (relative risk (RR) for LHR < 1, 1.65 (95% CI, 1.27-2.14)) and observed/expected LHR (standardized mean difference (SMD), -0.70 (95% CI, -0.98 to -0.42)) measured by ultrasound and observed/expected total lung volume (SMD, -1.00 (95% CI, -1.52 to -0.48)) measured by magnetic resonance imaging. Liver herniation was also associated with an increased risk of need for ECMO (RR, 3.04 (95% CI, 2.23-4.14)). These results were confirmed by a sensitivity analysis of studies that included only expectantly managed cases. Data on vascular assessment for the prediction of PPH could not be pooled as most of the parameters were evaluated in a single series or in different series by the same principal investigator. CONCLUSIONS: In fetuses with CDH, lung size and liver herniation predict the need for ECMO, however a predictor for PPH is still lacking. Further studies aimed at diagnosing impaired vascular development in utero should therefore be undertaken.
Authors: Suzan Cochius-den Otter; Jan A Deprest; Laurent Storme; Anne Greenough; Dick Tibboel Journal: Front Pediatr Date: 2022-04-15 Impact factor: 3.569
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Authors: Katinka Weller; Nina C J Peters; Joost van Rosmalen; Suzan C M Cochius-Den Otter; Philip L J DeKoninck; Rene M H Wijnen; Titia E Cohen-Overbeek; Alex J Eggink Journal: Prenat Diagn Date: 2021-07-28 Impact factor: 3.242
Authors: D Basurto; N Sananès; T Bleeser; I Valenzuela; N De Leon; L Joyeux; E Verbeken; S Vergote; L Van der Veeken; F M Russo; J Deprest Journal: Ultrasound Obstet Gynecol Date: 2021-01 Impact factor: 8.678
Authors: Lennart Van der Veeken; Francesca Maria Russo; Luc De Catte; Eduard Gratacos; Alexandra Benachi; Yves Ville; Kypros Nicolaides; Christoph Berg; Glenn Gardener; Nicola Persico; Pietro Bagolan; Greg Ryan; Michael A Belfort; Jan Deprest Journal: Gynecol Surg Date: 2018-05-08