Survival of severe congenital diaphragmatic hernia has morbid consequences

Fetal tracheal occlusion (TO) was developed in an attempt to enhance prenatal lung growth and improve survival in fetuses with severe congenital diaphragmatic hernia (CDH). We conducted a randomized, controlled clinical trial in 24 fetuses with severe left CDH (liver herniated into the thorax and lo...

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Bibliographic Details
Published in:Journal of pediatric surgery 2005, Vol.40 (1), p.36-46
Main Authors: Cortes, Raul A., Keller, Roberta L., Townsend, Tiffany, Harrison, Michael R., Farmer, Diana L., Lee, Hanmin, Piecuch, Robert E., Leonard, Carol H., Hetherton, Maria, Bisgaard, Robin, Nobuhara, Kerilyn K.
Format: Article
Language:English
Subjects:
Female
Fetoscopy
Follow-Up Studies
Growth Disorders - etiology
Hearing Disorders - etiology
Hernia, Diaphragmatic - complications
Hernia, Diaphragmatic - mortality
Hernia, Diaphragmatic - surgery
Humans
Infant
Infant, Newborn
Infant, Premature
Ligation - methods
Lung - abnormalities
Lung - embryology
Lung Diseases - congenital
Lung Diseases - etiology
Lung Diseases - prevention & control
Male
Perinatal Care - methods
Pregnancy
Prospective Studies
Trachea - surgery
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Summary:Fetal tracheal occlusion (TO) was developed in an attempt to enhance prenatal lung growth and improve survival in fetuses with severe congenital diaphragmatic hernia (CDH). We conducted a randomized, controlled clinical trial in 24 fetuses with severe left CDH (liver herniated into the thorax and low lung-to-head ratio) to compare survival after endoscopic fetal TO vs standard perinatal care (control) and prospectively followed up the 16 survivors (9 control, 7 TO) to compare neurodevelopmental, respiratory, surgical, growth, and nutritional outcomes. At 1 and 2 years old, subjects underwent evaluation consisting of medical and neurological history and physical, developmental testing, nutritional assessment, oxygen saturation and pulmonary function testing, chest radiograph, and echocardiogram. Growth and developmental measures were corrected for prematurity. Data were analyzed by Mann-Whitney rank sum test, Fisher's Exact test, and logistic and linear regression. Infants with TO were significantly more premature at birth (control vs TO, 37.4 ± 1.0 vs 31.1 ± 1.7 weeks; P < .01). Growth failure ( z score for weight
ISSN:0022-3468
1531-5037
DOI:10.1016/j.jpedsurg.2004.09.037