Speciality
Spotlight

 




 


Neonatal & Perinatal


    

 




Congenital Malformations Management- Fetus

  

  • Correction of Congenital Diaphragmatic Hernia in Utero : IX Fetuses with poor Prognosis (Liver Herniation and Low Lung-to-head Ratio) Can Be Saved by Fetoscopic Temporary Tracheal Occlusion

    Harrison MR, Mychaliska GB, Albanese CT, et al (Univ of California, San Francisco)


     J Pediatr Surg 33: 1017-1023, 1998


       


    A poor prognosis in fetuses with congenital diaphragmatic hernias (CDHs) may be determined by the following: liver herniation, diagnosed before 25 weeks, gestation, and a low lung-to-head ratio. Complete in utero repair is unsuccessful in these patient. Temporary tracheal occlusion of 3 different treatment approaches were assessed in patiernts with CDHS and poor prognoses.

       


    Thirty-four of 86 fetuses with isolated left CDHs met criteria for the poor-prognosis group during a 3-year evaluation period. Treatment of the patients was as follows : 13 underwent postnatal treatment at an extracorporeal membrane oxygenation centre, 13 underwent open fetal tracheal occlusion, and 8 underwent fetoscopic tracheal occlusion (Fetendo). Fewer postoperative pulmonary complications occurred in mothers who underwent the Fetendo procedure compared with open tracheal occlusion. Twelve of 13 patients with Fetendo clips had a striking physiologic response: sonographic enlargement of the lung before birth and excellent immediate postnatal function. Dramatic enlargement of the small left lung was observed postnatally by plain radiographs and by subjective appearance during CDH repair. Five of 13 patients who underwent open tracheal occlusion had lung growth. 

      



    Conclusion :
    Fetuses with left CDHs with liver herniation and low lung-to-head ratios are at high risk for neonatal demise. They seem to benefit from temporary tracheal occlusion performed by video fetoscope but not by open fetal surgery which further adds to the sense of futility. 

       



    Editorial Comments L.P. Halamek, M.D.


    Previous attempts at prenatal intervention were complicated by the inability to select the subpopulation of fetuses most likely to benefit from this risky procedure. It now appears that this subpopulation with a poor prognosis for survival not only can be identified prenatally by noninvasive technology but also can be treated with a high degree of success.

      

 



 

 

Speciality Spotlight

 

 

Congenital Malformations Management- Fetus
  

  • Correction of Congenital Diaphragmatic Hernia in Utero : IX Fetuses with poor Prognosis (Liver Herniation and Low Lung-to-head Ratio) Can Be Saved by Fetoscopic Temporary Tracheal Occlusion
    Harrison MR, Mychaliska GB, Albanese CT, et al (Univ of California, San Francisco)
     J Pediatr Surg 33: 1017-1023, 1998
       
    A poor prognosis in fetuses with congenital diaphragmatic hernias (CDHs) may be determined by the following: liver herniation, diagnosed before 25 weeks, gestation, and a low lung-to-head ratio. Complete in utero repair is unsuccessful in these patient. Temporary tracheal occlusion of 3 different treatment approaches were assessed in patiernts with CDHS and poor prognoses.
       
    Thirty-four of 86 fetuses with isolated left CDHs met criteria for the poor-prognosis group during a 3-year evaluation period. Treatment of the patients was as follows : 13 underwent postnatal treatment at an extracorporeal membrane oxygenation centre, 13 underwent open fetal tracheal occlusion, and 8 underwent fetoscopic tracheal occlusion (Fetendo). Fewer postoperative pulmonary complications occurred in mothers who underwent the Fetendo procedure compared with open tracheal occlusion. Twelve of 13 patients with Fetendo clips had a striking physiologic response: sonographic enlargement of the lung before birth and excellent immediate postnatal function. Dramatic enlargement of the small left lung was observed postnatally by plain radiographs and by subjective appearance during CDH repair. Five of 13 patients who underwent open tracheal occlusion had lung growth. 
      
    Conclusion : Fetuses with left CDHs with liver herniation and low lung-to-head ratios are at high risk for neonatal demise. They seem to benefit from temporary tracheal occlusion performed by video fetoscope but not by open fetal surgery which further adds to the sense of futility. 
       
    Editorial Comments L.P. Halamek, M.D.
    Previous attempts at prenatal intervention were complicated by the inability to select the subpopulation of fetuses most likely to benefit from this risky procedure. It now appears that this subpopulation with a poor prognosis for survival not only can be identified prenatally by noninvasive technology but also can be treated with a high degree of success.
      

 

 

By |2022-07-20T16:41:57+00:00July 20, 2022|Uncategorized|Comments Off on Fetus

About the Author: