Ultrasound Obstet Gynecol

. 2020 Sep 13. doi: 10.1002/uog.23115. Online ahead of print. https://pubmed.ncbi.nlm.nih.gov/32924187/

Fetoscopic endoluminal tracheal occlusion reverses the natural history of right-sided congenital diaphragmatic hernia: a European multicenter experience

F M Russo ^1 2, A-G Cordier ^3 4, D Basurto ², L Salazar ⁵, E Litwinska ⁶, O Gomez ⁵, A Debeer ^2 7, J Nevoux ⁸, S Patel ⁹, L Lewi ^1 2, A Pertierra ¹⁰, M Aertsen ^11 12, E Gratacos ⁵, K Nicolaides ⁶, A Benachi ^3 4, J Deprest ^1 2Affiliations expand

• PMID: 32924187
• DOI: 10.1002/uog.23115

Abstract

Objective: To examine neonatal outcome of fetuses with isolated right-sided congenital diaphragmatic hernia (iRCDH) based on prenatal severity indicators and antenatal management.

Methods: Retrospective review of prospectively collected data on consecutive cases of iRCDH diagnosed prior to 30 weeks’ gestation. Data on prenatal severity assessment, antenatal management, and perinatal outcome were retrieved. Univariate and multivariate logistic regression analysis were used to identify predictors of survival at discharge and early neonatal morbidity.

Results: Forty out of 265 assessed patients underwent termination of pregnancy (15%), while in two (0.7%) cases unexplained fetal death occurred. In the fetuses with iRCDH included in neonatal outcome analysis, 86 were managed expectantly during pregnancy and 128 underwent fetoscopic tracheal occlusion with a balloon (FETO). In the expectant management group, lung size measured by ultrasound or by magnetic resonance imaging was the only independent predictor of survival (observed-to-expected lung-to-head ratio, o/eLHR: OR 1.02, 95% CI 1.02-1.1;p=0.003). Till now, stratification was based on a cut-off of 45%. Survival rate was 15% (4/27) in those with o/eLHR <45% and 61% (36/59) for o/eLHR ≥45% (p=0.001). The best cut-off for o/eLHR however was 50% (78% sensitivity and 72% specificity). Survivors with severe pulmonary hypoplasia stayed longer in the neonatal intensive care unit (NICU). In fetuses with an o/eLHR<45% treated by FETO, survival was higher (41%, 49/120) than in the expectantly managed with similar lung size (p=0.014), despite higher prematurity rates (gestational age at birth: 34.4±2.7 vs 36.8±3.0;p<0.0001). In antenatally treated fetuses, gestational age at birth was the only predictor of survival (OR 1.25, 95% CI 1.04-1.50;p=0.02).

Conclusions: Antenatal measurement of lung size predicts survival in iRCDH. In fetuses with severe lung hypoplasia, FETO was associated with a significant increase in survival. This article is protected by copyright. All rights reserved.

Keywords: Congenital diaphragmatic hernia; fetal therapy; prognosis; survival; ultrasound.

This article is protected by copyright. All rights reserved.