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Usefulness of lung‐to‐head ratio and intrapulmonary arterial Doppler in predicting neonatal morbidity in fetuses with congenital diaphragmatic hernia treated with fetoscopic tracheal occlusion
Author(s) -
CruzMartinez R.,
Castañon M.,
MorenoAlvarez O.,
AcostaRojas R.,
Martinez J. M.,
Gratacos E.
Publication year - 2013
Publication title -
ultrasound in obstetrics and gynecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.202
H-Index - 141
eISSN - 1469-0705
pISSN - 0960-7692
DOI - 10.1002/uog.11212
Subject(s) - medicine , congenital diaphragmatic hernia , bronchopulmonary dysplasia , gestational age , diaphragmatic hernia , cardiology , fetus , laser doppler velocimetry , anesthesia , hernia , surgery , pregnancy , blood flow , genetics , biology
ABSTRACT Objective To explore the potential value of intrapulmonary artery Doppler velocimetry in predicting neonatal morbidity in fetuses with left‐sided congenital diaphragmatic hernia ( CDH ) treated with fetoscopic tracheal occlusion ( FETO ). Methods Observed/expected lung‐to‐head ratio (O/E‐ LHR ), and intrapulmonary Doppler pulsatility index and peak early‐diastolic reversed flow were evaluated within 24 h before FETO in a consecutive cohort of 51 fetuses with left‐sided CDH at between 24 and 33 weeks' gestation. Lung Doppler parameters were converted into Z‐scores and defined as abnormal if the pulsatility index had a Z ‐score of > 1.0 or the peak early‐diastolic reversed flow had a Z ‐score of > 3.5. The association of O/E‐ LHR and Doppler velocimetry with neonatal outcome was assessed using multiple linear or logistic regression analysis adjusted for gestational age at birth. Results Among the 26 fetuses that survived, 18 (69.2%) had normal and eight (30.8%) had abnormal Doppler values. O/E‐ LHR was not associated with neonatal morbidity in surviving fetuses. Compared with the group with normal Doppler parameters, cases with abnormal intrapulmonary Doppler were associated with a significant increase in the duration of mechanical ventilation (average increase of 21.2 (95% CI , 9.99–32.5) days; P < 0.01), conventional ventilation (15.2 (95% CI , 7.43–23.0) days; P < 0.01), high‐frequency ventilation (6.34 (95% CI , 0.69–11.99) days; P < 0.05), nitric oxide therapy (5.73 (95% CI , 0.60–10.9) days; P < 0.05), oxygen support (36.5 (95% CI , 16.3–56.7) days; P < 0.01), parenteral nutrition (19.1 (95% CI , 7.53–30.7) days; P < 0.01) and stay in neonatal intensive care unit (42.7 (95% CI , 22.9–62.6) days; P < 0.001), and with significantly higher rates of high‐frequency ventilation (87.5 vs 44.4%; P < 0.05), oxygen requirement at 28 days of age (75.0 vs 11.1%; P < 0.01), gastroesophageal reflux (62.5 vs 22.2%; P < 0.05) and tube feeding at discharge (37.5 vs 5.56%; P < 0.05). Conclusion As previously reported, O/E‐ LHR did not predict neonatal morbidity. In contrast, intrapulmonary artery Doppler evaluation was predictive of neonatal morbidity in CDH fetuses treated with FETO .Copyright © 2012 ISUOG. Published by John Wiley & Sons, Ltd.