Eur J Pediatr Surg
. 2023 Jul 20.
doi: 10.1055/a-2133-8380. Online ahead of print. https://pubmed.ncbi.nlm.nih.gov/37473779/
Maternal and Neonatal Outcomes After Ex-Utero Intrapartum Treatment for Congenital Diaphragmatic Hernia: A Case Series
Ángel Chimenea Toscano 1, Marta Dominguez-Moreno 1, María Barrera-Talavera 1, Lutgardo García-Díaz 1 2, Guillermo Antiñolo 1 2
Affiliations expand
- PMID: 37473779
- DOI: 10.1055/a-2133-8380
Abstract
Introduction: Despite advances in neonatal intensive care, fetuses with congenital diaphragmatic hernia (CDH) remain to have a poor prognosis. Exclusive postnatal treatment is inadequate in patients with moderate CDH (O/E LHR 26 to 45%), and can lead to respiratory failure at birth, requiring ECMO in 75% of cases. Ex-utero intrapartum treatment (EXIT) procedure may be beneficial in these cases, improving the fetal-neonatal transition.
Material and methods: We review all pregnancies with fetal isolated left CDH with moderate O/E LHR delivered by EXIT in our center from January 2007 to December 2022. Maternal and neonatal variables were analyzed. As primary outcomes, we included neonatal survival and mortality rates, surgical and infectious complications, uterine scar dehiscence, and blood loss during EXIT. As secondary outcomes, we studied recurrences of the diaphragmatic defect, long-term evolution, subsequent pregnancies, and mode of delivery.
Results: A total of 14 patients were delivered by EXIT procedure, with a neonatal survival rate of 85.7%. All these children have an optimal physical and neurocognitive development, and no pulmonary morbidity. We found no major complications, and 7.1% of minor maternal complications. There were no cases of surgical wound infection or endometritis. The median decrease in Hemoglobin during EXIT procedure was 1.9 mg/dl, and only one case required postoperative transfusion. Two out of the 14 women became pregnant again, and both pregnancies were uneventful.
Conclusions: In our series, EXIT procedure allows for adequate airway management associated with a high neonatal survival rate in patients with moderate O/E LHR CDH, with a low rate of neonatal and maternal complications.
Thieme. All rights reserved.
