Fetal lung maturation in congenital diaphragmatic hernia

• Published in: American journal of obstetrics and gynecology 1995-11, Vol.173 (5), p.1401-1405
• Main Authors: Moya, Fernando R., Thomas, Vickey L., Romaguera, Josefina, Mysore, Mohan R., Maberry, Mark, Bernard, Alfred, Freund, Margarida
• Format: Article
• Language: English
• Subjects: Amniocentesis; Biological and medical sciences; Biomarkers - analysis; Congenital diaphragmatic hernia; Diseases of mother, fetus and pregnancy; Extracorporeal Membrane Oxygenation; Female; Fetal Death; fetal lung maturation; Fetus; Gestational Age; Glycoproteins - analysis; Gynecology. Andrology. Obstetrics; Hernia, Diaphragmatic - diagnosis; Hernia, Diaphragmatic - physiopathology; Hernias, Diaphragmatic, Congenital; Humans; Lung - embryology; Medical sciences; Phosphatidylcholines - analysis; Pregnancy; Pregnancy. Fetus. Placenta; Proteolipids - analysis; Pulmonary Surfactant-Associated Proteins; Pulmonary Surfactants - analysis; Reference Values; surfactant phospholipids; surfactant protein A
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1016/0002-9378(95)90624-X

OBJECTIVE: Our purpose was to determine whether congenital diaphragmatic hernia is associated with abnormalities of fetal lung maturation. STUDY DESIGN: We measured surfactant protein A and saturated phosphatidylcholine in amniotic fluid from 19 pregnancies with a prenatal diagnosis of congenital diaphragmatic hernia (gestational age 16 to 40 weeks) and 48 control pregnancies (gestational age 16 to 39 weeks). Results were compared by analysis of covariance. RESULTS: Beyond 34 weeks of gestation there was a progressive rise in amniotic fluid surfactant protein A and saturated phosphatidylcholine in control pregnancies, whereas in most fetuses with prenatal diagnosis of congenital diaphragmatic hernia these values remained low ( p < 0.01). Amniotic fluid surfactant protein A was lower in fetuses with congenital diaphragmatic hernia who died or required extracorporeal membrane oxygenation than in survivors treated with conventional management (4.9 ± 2.9 vs 16.8 ± 5.7 μg/ml surfactant protein A, respectively, p < 0.05 by Mann-Whitney U test). CONCLUSIONS: There are decreased surfactant components in amniotic fluid in many pregnancies complicated by congenital diaphragmatic hernia, which may reflect fetal lung immaturity or hypoplasia.