Journal of pediatric surgery · 2013
Outcome of CDH infants following fetoscopic tracheal occlusion - influence of premature delivery.
СтатьяПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Ali Kamal, Grigoratos Dionysios, Cornelius Victoria, Davenport Mark, Nicolaides Kypros, Greenough Anne
Аннотация
PURPOSE: To evaluate the mortality and morbidity of infants with congenital diaphragmatic hernia who had undergone fetal endoscopic tracheal occlusion (FETO) and whether this was influenced by premature birth.
METHODS: The gestational age at delivery, lung-head ratio (LHR) pre and post FETO, neonatal outcomes, and respiratory, gastro-intestinal, neurological, surgical, and musculoskeletal problems at follow up of consecutive infants who had undergone FETO were determined. Elective reversal of FETO was planned at 34 weeks of gestation.
RESULTS: The survival rate of the 61 FETO infants was 48%, with 84% delivered prematurely. Thirty-one delivered <35 weeks of gestation. Their survival rate was 18%. Twenty-three of 24 infants who had emergency balloon removal were born <35 weeks of gestation. Survival was related to gestational age at delivery (OR 0.55, 95% CI 0.420, 0.77, p<0.001) and the duration of FETO (OR 0.73, 95% CI 0.59, 0.91, p<0.005). Infants born prior to 35 weeks of gestation compared to those born at ≥ 35 weeks required a longer duration of ventilation (median 45 days versus 12 days, p<0.001), and a greater proportion had surgery for gastro-oesophageal reflux (50% versus 9%, p=0.011).
CONCLUSION: These results emphasize the need to reduce premature delivery following FETO.
METHODS: The gestational age at delivery, lung-head ratio (LHR) pre and post FETO, neonatal outcomes, and respiratory, gastro-intestinal, neurological, surgical, and musculoskeletal problems at follow up of consecutive infants who had undergone FETO were determined. Elective reversal of FETO was planned at 34 weeks of gestation.
RESULTS: The survival rate of the 61 FETO infants was 48%, with 84% delivered prematurely. Thirty-one delivered <35 weeks of gestation. Their survival rate was 18%. Twenty-three of 24 infants who had emergency balloon removal were born <35 weeks of gestation. Survival was related to gestational age at delivery (OR 0.55, 95% CI 0.420, 0.77, p<0.001) and the duration of FETO (OR 0.73, 95% CI 0.59, 0.91, p<0.005). Infants born prior to 35 weeks of gestation compared to those born at ≥ 35 weeks required a longer duration of ventilation (median 45 days versus 12 days, p<0.001), and a greater proportion had surgery for gastro-oesophageal reflux (50% versus 9%, p=0.011).
CONCLUSION: These results emphasize the need to reduce premature delivery following FETO.
Предметные рубрики MeSH
CephalometryDelivery, ObstetricElective Surgical ProceduresFemaleFetal Organ MaturityFetoscopyFollow-Up StudiesGastroesophageal RefluxGestational AgeHeadHernia, DiaphragmaticHernias, Diaphragmatic, CongenitalHumansInfant, NewbornInfant, PrematureInfant, Premature, DiseasesKaplan-Meier EstimateLungObstetric Labor, PrematurePregnancyRecurrenceRetrospective StudiesSurvival RateTherapeutic OcclusionTracheaTreatment Outcome