Prenatal prognosis in isolated congenital diaphragmatic hernia

Datin-Dorrière, Valérie; Rouzies, Sarah; Taupin, Pierre; Walter-Nicolet, E.; Benachi, Alexandra; Sonigo, P.; Mitanchez, Delphine

doi:10.1016/j.ajog.2007.06.069

Cited by 83 publications

(59 citation statements)

References 24 publications

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“…Survivors were operated on at a median age of 2.0 (range, [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] days; 77% of them required a patch augmented repair. Full enteral feeding was possible at 26 (range, 5-150) days of age.…”

Section: Postnatal Morbidity Indices and Their Predictors In The Fetomentioning

confidence: 99%

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

Doné

Gratacós

Nicolaides

et al. 2013

Ultrasound in Obstet & Gyne

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Section: Postnatal Morbidity Indices and Their Predictors In The Fetomentioning

confidence: 99%

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

Doné

Gratacós

Nicolaides

et al. 2013

Ultrasound in Obstet & Gyne

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“…It is associated with high mortality and although improvements in medical and surgical management have improved the outlook, survival remains at 60-70% [1][2][3][4][5][6]. Newer modalities, including antenatal screening and intervention, are available but are often introduced without formal evaluation.…”

mentioning

confidence: 99%

Congenital diaphragmatic hernia

Kotecha¹,

Barbato²,

Bush³

et al. 2011

Eur Respir J

140

122

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Infants with congenital diaphragmatic hernia (CDH) have significant mortality and long-term morbidity. Only 60-70% survive and usually those in high-volume centres. The current Task Force, therefore, has convened experts to evaluate the current literature and make recommendations on both the antenatal and post-natal management of CDH. The incidence of CDH varies from 1.7 to 5.7 per 10,000 live-born infants depending on the study population. Antenatal ultrasound scanning is routine and increasingly complemented by the use of magnetic resonance imaging. For isolated CDH, antenatal interventions should be considered, but the techniques need vigorous evaluation. After birth, management protocols are often used and have improved outcome in nonrandomised studies, but immediate intubation at birth and gentle ventilation are important. Pulmonary hypertension is common and its optimal management is crucial as its severity predicts the outcome. Usually, surgery is delayed to allow optimal medical stabilisation. The role of minimal invasive post-natal surgery remains to be further defined. There are differences in opinion about whether extracorporeal membrane oxygenation improves outcome. Survivors of CDH can have a high incidence of comorbidities; thus, multidisciplinary follow-up is recommended. Multicentre international trials are necessary to optimise the antenatal and post-natal management of CDH patients.

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“…Although the latter number remains undefined, recent data indicate that the condition is lethal in 10 to 30% of cases (Stege et al, 2003;Javid et al, 2004;Sartoris et al, 2006;Gallot et al, 2007;Hedrick et al, 2007;Datin-Dorriere et al, 2008) (Table 5). Further, this subset must be identifiable prior to birth.…”

Section: Clinical Experience With Prenatal Intervention For Cdhmentioning

confidence: 99%

The making of fetal surgery

et al. 2010

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Fetal diagnosis prompts the question for fetal therapy in highly selected cases. Some conditions are suitable for in utero surgical intervention. This paper reviews historically important steps in the development of fetal surgery. The first invasive fetal intervention in 1963 was an intra-uterine blood transfusion. It took another 20 years to understand the pathophysiology of other candidate fetal conditions and to develop safe anaesthetic and surgical techniques before the team at the University of California at San Francisco performed its first urinary diversion through hysterotomy. This procedure would be abandoned as renal and pulmonary function could be just as effectively salvaged by ultrasound-guided insertion of a bladder shunt. Fetoscopy is another method for direct access to the feto-placental unit. It was historically used for fetal visualisation to guide biopsies or for vascular access but was also abandoned following the introduction of high-resolution ultrasound. Miniaturisation revived fetoscopy in the 1990s, since when it has been successfully used to operate on the placenta and umbilical cord. Today, it is also used in fetuses with congenital diaphragmatic hernia (CDH), in whom lung growth is triggered by percutaneous tracheal occlusion. It can also be used to diagnose and treat urinary obstruction. Many fetal interventions remain investigational but for a number of conditions randomised trials have established the role of in utero surgery, making fetal surgery a clinical reality in a number of fetal therapy programmes. The safety of fetal surgery is such that even non-lethal conditions, such as myelomeningocoele repair, are at this moment considered a potential indication. This, as well as fetal intervention for CDH, is currently being investigated in randomised trials.

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Prenatal prognosis in isolated congenital diaphragmatic hernia

Cited by 83 publications

References 24 publications

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

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

Congenital diaphragmatic hernia

The making of fetal surgery

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