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Prenatal diagnosis, prediction of outcome and in utero therapy of isolated congenital diaphragmatic hernia
Author(s) -
Doné Elisa,
Gucciardo Leonardo,
Van Mieghem Tim,
Jani Jacques,
Cannie Mieke,
Van Schoubroeck Dominique,
Devlieger Roland,
Catte Luc De,
Klaritsch Philipp,
Mayer Steffi,
Beck Veronika,
Debeer Anne,
Gratacos Eduardo,
Nicolaides Kypros,
Deprest Jan
Publication year - 2008
Publication title -
prenatal diagnosis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.956
H-Index - 97
eISSN - 1097-0223
pISSN - 0197-3851
DOI - 10.1002/pd.2033
Subject(s) - congenital diaphragmatic hernia , in utero , prenatal diagnosis , medicine , diaphragmatic hernia , hernia , diaphragmatic breathing , obstetrics , pediatrics , pregnancy , outcome (game theory) , surgery , fetus , pathology , biology , genetics , alternative medicine , mathematics , mathematical economics
Congenital diaphragmatic hernia (CDH) can be associated with genetic or structural anomalies with poor prognosis. In isolated cases, survival is dependent on the degree of lung hypoplasia and liver position. Cases should be referred in utero to tertiary care centers familiar with this condition both for prediction of outcome as well as timed delivery. The best validated prognostic indicator is the lung area to head circumference ratio. Ultrasound is used to measure the lung area of the index case, which is then expressed as a proportion of what is expected normally (observed/expected LHR). When O/E LHR is < 25% survival chances are < 15%. Prenatal intervention, aiming to stimulate lung growth, can be achieved by temporary fetal endoscopic tracheal occlusion (FETO). A balloon is percutaneously inserted into the trachea at 26–28 weeks, and reversal of occlusion is planned at 34 weeks. Growing experience has demonstrated the feasibility and safety of the technique with a survival rate of about 50%. The lung response to, and outcome after FETO, is dependent on pre‐existing lung size as well gestational age at birth. Early data show that FETO does not increase morbidity in survivors, when compared to historical controls. Several trials are currently under design. Copyright © 2008 John Wiley & Sons, Ltd.