Ultrasound Obstet Gynecol. 2020 May 27. doi: 10.1002/uog.22086. [Epub ahead of print] https://pmlegacy.ncbi.nlm.nih.gov/pubmed/32462707
Prenatal stomach position predicts gastrointestinal morbidity at 2 years in fetuses with congenital diaphragmatic hernia.
Cordier AG1,2, Laup L1, Letourneau A1,2, Le Sache N2,3, Fouquet V2,4, Senat MV2,5, Perrotin F6, Rosenblatt J7, Sananes N8, Jouannic JM9, Benoist G10, Jani JC10, Benachi A1,2.
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Abstract
OBJECTIVE:
The long-term morbidity of isolated left-sided congenital diaphragmatic hernia (L-CDH) has already been described. However, antenatal criteria impacting gastrointestinal morbidity (GIM) are not yet defined. The objective of this study was to evaluate the effect of fetal stomach position on GIM at 2 years.
METHODS:
A retrospective, observational and multicenter cohort study was conducted from January 2010 to January 2014. Patients whose fetuses had isolated L-CDH, with or without fetoscopic endoluminal tracheal occlusion (FETO), were included. Prenatal maternal, fetal and pediatric data were collected. Fetal stomach position was evaluated a posteriori by two observers using ultrasound images of the four-chamber view of the heart to calculate the lung area-to-head circumference ratio (LHR). The primary outcome was GIM at 2 years assessed in a composite manner. Regression analysis was performed in order to investigate the effect on various GIM outcome variables, of LHR, stomach position and FETO.
RESULTS:
Forty-seven patients were included in the analysis. Thirteen (27.7%) infants did not meet the criterion of exclusive oral feeding at 2 years of age. The position of the stomach was significantly and independently associated with the duration of parenteral nutrition (OR 19.86, p = 0.031) and the persistence of oral aversion at 2 years (OR 3.40, p = 0.006). FETO does not seem to affect GIM.
CONCLUSION:
In isolated L-CDH, fetal stomach position is the only predictive factor of GIM at 2 years. This article is protected by copyright. All rights reserved.
This article is protected by copyright. All rights reserved.
KEYWORDS:
antenatal predictive factor; congenital diaphragmatic hernia; gastrointestinal morbidity; stomach positionPMID: 32462707 DOI: 10.1002/uog.22086
