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Advisor(s)
Abstract(s)
OBJECTIVE: To estimate the response in lung growth
and vascularity after fetal endoscopic tracheal occlusion
for severe congenital diaphragmatic hernia in the prediction
of neonatal survival.
METHODS: Between January 2006 and December 2010,
fetal lung parameters (observed-to-expected lung-tohead
ratio; observed-to-expected lung volume; and contralateral
lung vascularization index) were evaluated before
fetal tracheal occlusion and were evaluated
longitudinally every 2 weeks in 72 fetuses with severe
isolated congenital diaphragmatic hernia. Thirty-five fetuses
underwent fetal endoscopic tracheal occlusion and
37 cases did not.
RESULTS: Survival rate was significantly higher in the
fetal endoscopic tracheal occlusion group (54.3%) than in
the no fetal endoscopic tracheal occlusion group (5.4%,
P<.01). Fetal endoscopic tracheal occlusion resulted in a
significant improvement in fetal lung size and pulmonary
vascularity when compared with fetuses that did not go
to the fetal intervention (increase of the observed-toexpected
lung-to-head ratio, observed-to-expected total
lung volume, and contralateral pulmonary vascularization
index 56.2% compared with 0.3%, 37.9% compared with
0.1%, and 98.6% compared with 0.0%, respectively;
P<.01). Receiver operating characteristic curves indicated
that the observed-to-expected total fetal lung
volume was the single best predictor of neonatal survival
before fetal endoscopic tracheal occlusion (cutoff 0.23,
area under the curve [AUC] 0.88, relative risk 5.3, 95%
confidence interval [CI] 1.4 –19.7). However, the contralateral
lung vascularization index at 4 weeks after fetal
endoscopic tracheal occlusion was more accurate in the
prediction of neonatal outcome (cutoff 24.0%, AUC 0.98,
relative risk 9.9, 95% CI 1.5– 66.9) with the combination of
observed-to-expected lung volumes and contralateral
lung vascularization index at 4 weeks being the best
predictor of outcome (AUC 0.98, relative risk 16.6, 95% CI
2.5–112.3).
CONCLUSION: Fetal endoscopic tracheal occlusion improves
survival rate by increasing the lung size and
pulmonary vascularity in fetuses with severe congenital
diaphragmatic hernia. The pulmonary response after fetal
endoscopic tracheal occlusion can be used to predict
neonatal survival.
Description
Keywords
Citation
Obstetrics & Gynecology, 119, 93-101
Publisher
Lippincott Williams & Wilkins