Predictors of neonatal morbidity in fetuses with severe isolated congenital diaphragmatic hernia undergoing fetoscopic tracheal occlusion

Doné, Elisa; Gratacós, Eduard; Nicolaides, Kypros H.; Allegaert, Karel; Valencia, Catalina; Castañón, M; Martı́nez, J.; Jani, Jacques; Mieghem, Tim Van; Greenough, Anne; Gómez, O.; Lewi, Paul; Deprest, Jan

doi:10.1002/uog.12445

Cited by 86 publications

(103 citation statements)

References 42 publications

(84 reference statements)

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“…More premature delivery in FETO infants has been well documented and is the consequence of complications related to balloon insertion [1,12]. Gestational age at birth has been reported in FETO infants to be predictive of the durations of ventilation and supplementary oxygen and the age at full enteral feeds [7]. If delivery, however, took place after 34 weeks of gestation, neonatal morbidity of FETO cases was comparable with that of expectantly managed cases [7].…”

Section: Discussionmentioning

confidence: 99%

Congenital diaphragmatic hernia—influence of fetoscopic tracheal occlusion on outcomes and predictors of survival

et al. 2016

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• Randomised controlled trials have demonstrated that foetal endotracheal occlusion (FETO) in high risk infants with congenital diaphragmatic hernia is associated with a higher survival rate. • Mortality is greater in foetuses who underwent FETO and delivered prior to 35 weeks of gestation. What is New: • Infants who had undergone FETO compared to those who had not had significantly longer durations of mechanical ventilation, supplementary oxygen and hospital stay. • Regardless of antenatal intervention, the lowest oxygenation index in the first 24 h was the best predictor of survival.

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Section: Discussionmentioning

confidence: 99%

Congenital diaphragmatic hernia—influence of fetoscopic tracheal occlusion on outcomes and predictors of survival

et al. 2016

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“…A recent prospective multi-centre study investigated the neonatal outcome following foetal therapy in isolated CDH cases with severe hypoplasia and thus a predicted poor outcome. For neonates born after 34 weeks' gestation, the early neonatal morbidity in the FETO cases was comparable to that of expectantly managed cases with moderate hypoplasia [6]. The effectiveness of foetal therapy is currently being formally assessed in a randomised controlled trial for foetuses with predicted moderate and severe pulmonary hypoplasia (www.totaltrial.eu) [7].…”

Section: Introductionmentioning

confidence: 99%

Clinical Outcome for Congenital Diaphragmatic Hernia at the Age of 1 Year in the Era of Fetal Intervention

Ginderdeuren

Allegaert²,

Decaluwé³

et al. 2017

Neonatology

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Background: Congenital diaphragmatic hernia (CDH) is an abnormal development of the diaphragm leading to high neonatal mortality and morbidity. Beyond the neonatal period, prospective data on overall long-term outcome in CDH survivors is scarce. In particular, for those treated with fetoscopic endoluminal tracheal occlusion (FETO), a promising new technique to increase survival chances for severe cases, the outcomes are even less documented. Aim: To prospectively document the clinical outcome of CDH at 1 year including FETO-treated infants in relation to ante- and postnatal variables. Methods: A single-centre prospective clinical follow-up at 1 year of age included a standardised respiratory questionnaire. Results: Thirty-four CDH survivors were included, 10 of which were FETO-treated infants. At 1 year, the median weight z score was -1.50 (interquartile range [IQR]: -2.45 to -0.88) and 10/34 were “failure to thrive” (FTT) cases. Gastro-intestinal (GI) problems at 1 year were mainly related to gastro-oesophageal reflux (16/34) with a high need for tube feeding in the first year (9/34). Tachypnoea was present in 10/29 (34%) and 8/34 (24%) were on chronic inhaled medication. The median total respiratory symptom score was 20 (IQR: 13-32) and correlated with the number of neonatal ventilation days (p = 0.048). Hospital re-admission occurred in 19/34 infants (56%), and was for respiratory problems in almost half of them (8/19). Conclusion: In this CDH cohort, morbidity at 1 year was determined more by GI problems and FTT than respiratory morbidity. The respiratory questionnaire may, however, have underestimated the respiratory morbidity since respondents had a 1-in-4 chance to have persistent tachypnoea and be on chronic inhalation therapy.

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“…To stimulate lung maturation, it was proposed to reverse the occlusion already in utero (plug-unplug sequence), 3 which also clinically seems to improve survival and morbidity. 4,5 These preliminary observations are now being evaluated in a randomized controlled trial [http://www.totaltrial.eu, NIH NCT00763737 (moderate hypoplasia) and NIH NCT01240057 (severe hypoplasia)]. 6 A lack of understanding of the molecular mechanisms underlying pulmonary hypoplasia in CDH hampers progress for potential in utero therapies and case selection.…”

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confidence: 99%

Unique Tracheal Fluid MicroRNA Signature Predicts Response to FETO in Patients With Congenital Diaphragmatic Hernia

et al. 2015

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Objective and Background: Our objective was to determine the fetal in vivo microRNA signature in hypoplastic lungs of human fetuses with severe isolated congenital diaphragmatic hernia (CDH) and changes in tracheal and amniotic fluid of fetuses undergoing fetoscopic endoluminal tracheal occlusion (FETO) to reverse severe lung hypoplasia due to CDH. Methods: We profiled microRNA expression in prenatal human lungs by microarray analysis. We then validated this signature with real-time quantitative polymerase chain reaction in tracheal and amniotic fluid of CDH patients undergoing FETO. We further explored the role of miR-200b using semiquantitative in situ hybridization and immunohistochemistry for TGF-β2 in postnatal lung sections. We investigated miR-200b effects on TGF-β signaling using a SMAD-luciferase reporter assay and Western blotting for phospho-SMAD2/3 and ZEB-2 in cultures of human bronchial epithelial cells.

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Predictors of neonatal morbidity in fetuses with severe isolated congenital diaphragmatic hernia undergoing fetoscopic tracheal occlusion

Abstract: Objectives

Cited by 86 publications

References 42 publications

Congenital diaphragmatic hernia—influence of fetoscopic tracheal occlusion on outcomes and predictors of survival

Congenital diaphragmatic hernia—influence of fetoscopic tracheal occlusion on outcomes and predictors of survival

Clinical Outcome for Congenital Diaphragmatic Hernia at the Age of 1 Year in the Era of Fetal Intervention

Unique Tracheal Fluid MicroRNA Signature Predicts Response to FETO in Patients With Congenital Diaphragmatic Hernia

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