Single-Center Outcome of Fetoscopic Tracheal Balloon Occlusion for Severe Congenital Diaphragmatic Hernia.
Journal
Obstetrics and gynecology
ISSN: 1873-233X
Titre abrégé: Obstet Gynecol
Pays: United States
ID NLM: 0401101
Informations de publication
Date de publication:
03 2020
03 2020
Historique:
pubmed:
7
2
2020
medline:
1
9
2020
entrez:
7
2
2020
Statut:
ppublish
Résumé
To assess feasibility and maternal and infant outcome after fetoscopic tracheal balloon occlusion in patients with severe congenital diaphragmatic hernia. We conducted a prospective cohort study of fetuses with congenital diaphragmatic hernia and observed/expected lung/head ratio less than 30%. Eligible women had planned fetoscopic tracheal balloon occlusion at 26 0/7-29 6/7 weeks of gestation and balloon removal 4-6 weeks later. Standardized prenatal and postnatal care was at a single institution. Fetoscopic tracheal balloon occlusion details, lung growth, obstetric complications, birth outcome, and infant outcome details until discharge were evaluated. Of 57 women screened, 14 (25%) were enrolled between 2015 and 2019. The congenital diaphragmatic hernia was left in 12 (86%); the pre-fetoscopic tracheal balloon occlusion observed/expected lung/head ratio was 23.2% (range 15.8-29.0%). At a median gestational age of 28 5/7 weeks (range 27 3/7-29 6/7), fetoscopic tracheal balloon occlusion was successful in all cases, and balloons remained in situ. Removal was elective in 10 (71%) patients, by ultrasound-guided needle puncture in eight (57%), and occurred at a median of 33 4/7 weeks of gestation (range 32 1/7-34 4/7; median occlusion 34 days, range 17-44). The post-fetoscopic tracheal balloon occlusion observed/expected lung/head ratio increased to a median of 62.8% (44.0-108) and fell to a median of 46.6% (range 30-92) after balloon removal (all Mann Whitney U, P<.003). For prevention of preterm birth, all patients received vaginal progesterone; 11 (79%) required additional tocolytics, three (21%) had vaginal pessary placement for cervical shortening, and five (36%) had amnioreduction for polyhydramnios. Median gestational age at birth was 39 2/7 weeks (range 33 6/7-39 4/7), with term birth in eight (57%) patients. Twelve (86%) neonates required high-frequency ventilation, and seven (50%) required extracorporeal membrane oxygenation for a median of 7 days (range 3-19). All neonates needed patch repair. Neonatal survival was 93% (n=13, 95% CI 49-100%), and survival to hospital discharge was 86% (n=12, 95% CI 44-100%). Fetoscopic tracheal balloon occlusion for severe congenital diaphragmatic hernia was feasible in our single-center setting, with few obstetric complications and favorable infant outcome. ClinicalTrials.gov, NCT02710968.
Identifiants
pubmed: 32028493
doi: 10.1097/AOG.0000000000003692
pii: 00006250-202003000-00004
doi:
Banques de données
ClinicalTrials.gov
['NCT02710968']
Types de publication
Clinical Trial
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
511-521Commentaires et corrections
Type : CommentIn
Références
Lally KP. Congenital diaphragmatic hernia. Curr Opin Pediatr 2002;14:486–90.
Sola JE, Bronson SN, Cheung MC, Ordonez B, Neville HL, Koniaris LG. Survival disparities in newborns with congenital diaphragmatic hernia: a national perspective. J Pediatr Surg 2010;45:1336–42.
Gray BW, Fifer CG, Hirsch JC, Tochman SW, Drongowski RA, Mychaliska GB, et al. Contemporary outcomes in infants with congenital heart disease and Bochdalek diaphragmatic hernia. Ann Thorac Surg 2013;95:929–34.
Snoek KG, Greenough A, van Rosmalen J, Capolupo I, Schaible T, Ali K, et al. Congenital diaphragmatic hernia: 10-year evaluation of survival, extracorporeal membrane oxygenation, and foetoscopic endotracheal occlusion in four high-volume centres. Neonatology 2018;113:63–8.
Jani JC, Cordier AG, Martinovic J, Peralta CF, Senat MV, Segers V, et al. Antenatal ultrasound prediction of pulmonary hypoplasia in congenital diaphragmatic hernia: correlation with pathology. Ultrasound Obstet Gynecol 2011;38:344–9.
Abbasi N, Ryan G, Johnson A, Cortes MS, Sangi-Haghpeykar H, Ye XY, et al. NAFTNet*. Reproducibility of fetal lung-to-head ratio in left diaphragmatic hernia across the North American Fetal Therapy Network (NAFTNet). Prenat Diagn 2019;39:188–94.
Jani JC, Nicolaides KH, Gratacós E, Vandecruys H, Deprest JA; FETO Task Group. Fetal lung-to-head ratio in the prediction of survival in severe left-sided diaphragmatic hernia treated by fetal endoscopic tracheal occlusion (FETO). Am J Obstet Gynecol 2006;195:1646–50.
Jani JC, Benachi A, Nicolaides KH, Allegaert K, Gratacós E, Mazkereth R, et al. Prenatal prediction of neonatal morbidity in survivors with congenital diaphragmatic hernia: a multicenter study. Ultrasound Obstet Gynecol 2009;33:64–9.
Van Den Hout L, Schaible T, Cohen-Overbeek TE, Hop W, Siemer J, van de Ven K, et al. Actual outcome in infants with congenital diaphragmatic hernia: the role of a standardized postnatal treatment protocol. Fetal Diagn Ther 2011;29:55–63.
Putnam LR, Harting MT, Tsao K, Morini F, Yoder BA, Luco M, et al. Congenital diaphragmatic hernia defect size and infant morbidity at discharge. Pediatrics 2016;138:pii e20162043.
Jani JC, Nicolaides KH, Gratacos E, Valencia CM, Doné E, Martinez JM, et al. Severe diaphragmatic hernia treated by fetal endoscopic tracheal occlusion. Ultrasound Obstet Gynecol 2009;34:304–10.
Wilson JM, DeFiore JW, Peters CA. Experimental fetal tracheal ligation prevents the pulmonary hypoplasia associated with fetal nephrectomy: possible application for congenital diaphragmatic hernia. J Pediatr Surg 1993;28:1433–9.
Hedrick MH, Estes JM, Sullivan KM, Bealer JF, Kitterman JA, Flake AW, et al. Plug the lung until it grows (PLUG): a new method to treat congenital diaphragmatic hernia in utero. J Pediatr Surg 1994;29:612–7.
Flageole H, Evrard VA, Piedboeuf B, Laberge JM, Lerut TE, Deprest JA. The plug-unplug sequence: an important step to achieve type II pneumocyte maturation in the fetal lamb model. J Pediatr Surg 1998;33:299–303.
Van der Veeken L, Russo FM, De Catte L, Gratacos E, Benachi A, Ville Y, et al. Fetoscopic endoluminal tracheal occlusion and reestablishment of fetal airways for congenital diaphragmatic hernia. Gynecol Surg 2018;15:9.
DeKoninck P, Gomez O, Sandaite I, Richter J, Nawapun K, Eerdekens A, et al. Right-sided congenital diaphragmatic hernia in a decade of fetal surgery. BJOG 2015;122:940–6.
Hadlock FP, Harrist RB, Sharman RS, Deter RL, Park SK. Estimation of fetal weight with the use of head, body, and femur measurements–a prospective study. Am J Obstet Gynecol 1985;151:333–7.
Jani J, Nicolaides KH, Keller RL, Benachi A, Peralta CF, Favre R, et al. Observed to expected lung area to head circumference ratio in the prediction of survival in fetuses with isolated diaphragmatic hernia. Ultrasound Obstet Gynecol 2007;30:67–71.
Windrim R, Ryan G, Lebouthillier F, Campisi P, Kelly EN, Baud D, et al. Development and use of a high-fidelity simulator for fetal endotracheal balloon occlusion (FETO) insertion and removal. Prenat Diagn 2014;34:180–4.
Osborn AJ, Baud D, Macarthur AJ, Propst EJ, Forte V, Blaser SM, et al. Multidisciplinary perinatal management of the compromised airway on placental support: lessons learned. Prenat Diagn 2013;33:1080–7.
Carreras E, Arévalo S, Bello-Muñoz JC, Goya M, Rodó C, Sanchez-Duran MA, et al. Arabin cervical pessary to prevent preterm birth in severe twin-to-twin transfusion syndrome treated by laser surgery. Prenat Diagn 2012;32:1181–5.
The congenital diaphragmatic hernia study group: a voluntary international registry. Semin Pediatr Surg 2008;17:90–7.
Seravalli V, Jelin EB, Miller JL, Tekes A, Vricella L, Baschat AA. Fetoscopic tracheal occlusion for treatment of non-isolated congenital diaphragmatic hernia. Prenat Diagn 2017;37:1046–49.
Ruano R, Yoshisaki CT, da Silva MM, Ceccon ME, Grasi MS, Tannuri U, et al. A randomized controlled trial of fetal endoscopic tracheal occlusion versus postnatal management of severe isolated congenital diaphragmatic hernia. Ultrasound Obstet Gynecol 2012;39:20–7.
Persico N, Fabietti I, Ciralli F, Gentilino V, D'Ambrosi F, Boito S, et al. Fetoscopic endoluminal tracheal occlusion in fetuses with severe diaphragmatic hernia: a three-year single-center experience. Fetal Diagn Ther 2017;41:215–19.
Kosinski P, Wielgos M. Foetoscopic endotracheal occlusion (FETO) for severe isolated left-sided congenital diaphragmatic hernia: single center Polish experience. J Maten Fetal Neonatal Med 2018;31:2521–6.
Ruano R, Peiro JL, da Silva MM, Campos JA, Carreras E, Tannuri U, et al. Early fetoscopic tracheal occlusion for extremely severe pulmonary hypoplasia in isolated congenital diaphragmatic hernia: preliminary results. Ultrasound Obstet Gynecol 2013;42:70–6.
Peralta CF, Sbragia L, Bennini JR, de Fátima Assunção Braga A, Sampaio Rousselet M, Machado Rosa IR, et al. Fetoscopic endotracheal occlusion for severe isolated diaphragmatic hernia: initial experience from a single clinic in Brazil. Fetal Diagn Ther 2011;29:71–7.
Belfort MA, Olutoye OO, Cass DL, Olutoye OA, Cassady CI, Mehollin-Ray AR, et al. Feasibility and outcomes of fetoscopic tracheal occlusion for severe left diaphragmatic hernia. Obstet Gynecol 2017;129:20–9.
Chmait RH, Chan AH, Korst LM, Llanes A, Kontopoulos EV, Quinetro RA. Risks of preterm premature rupture of membranes and preterm birth post fetoscopy based on location of trocar insertion site. Am J Perinatol 2018;35:801–8.
Ali K, Grigoratos D, Cornelius V, Davenport M, Nicolaides K, Greenough A. Outcome of CDH infants following fetoscopic tracheal occlusion - influence of premature delivery. J Pediatr Surg 2013;48:1831–6.