The NeoAPACHE Study Protocol I: Assessment of the Radiographic Pulmonary Area and Long-Term Respiratory Function in Newborns With Congenital Diaphragmatic Hernia

Amodeo, Ilaria; Raffaeli, Genny; Pesenti, Nicola; Macchini, Francesco; Condò, Valentina; Borzani, Irene; Persico, Nicola; Fabietti, Isabella; Ophorst, Marijke; Ghirardello, Stefano; Gangi, Silvana; Colnaghi, Mariarosa; Mosca, Fabio; Cavallaro, Giacomo

doi:10.3389/fped.2020.581809

Cited by 7 publications

(19 citation statements)

References 31 publications

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“…Among survivors, lung area was also associated with hernia recurrence. As previously reported, our ndings suggest a possible role of radiographic measurement as an easy, non-invasive, and reproducible tool in the early prediction of mortality and morbidity among CDH patients 15 .…”

Section: Discussionsupporting

confidence: 83%

“…The radiographic assessment's reproducibility has already been demonstrated in the primary analysis, using the Bland Altman plot and calculating the Pearson Correlation index 15 .…”

Section: Discussionmentioning

confidence: 99%

“…As previously described, we enrolled all newborns having a preoperative chest X-ray performed within 24 h after birth at our NICU. Death within 1 hour, rotated, and air leak radiographs were excluded 15 . Surgery was performed as soon as the patient was clinically stable through median laparotomy with either primary repair or Gore-Tex ® patch insertion 33 .…”

Section: Subjectsmentioning

confidence: 99%

“…Each patient's pulmonary area was assessed by freehand tracing of the diaphragm and rib cage's perimeter, excluding the mediastinal structures and herniated organs 15 . If the anatomy was particularly disrupted, the only aerated portion of the lung was considered.…”

Section: Assessment Of Radiographic Pulmonary Areamentioning

confidence: 99%

“…The radiographic assessment of the lung area has been proposed as an alternative method to evaluate pulmonary hypoplasia soon after birth [11][12][13] . In newborns with CDH, lung area is correlated to the functional residual capacity measured through the diluted helium technique, and its increase is associated with tidal volume improvement in the rst year of life 14,15 . The chest radiographic thoracic area (CRTA) was also lower in patients with poor prognosis and was found to predict survival to discharge from the Neonatal Intensive Care Unit (NICU) better than lung to head ratio (LHR) 16 .…”

Section: Introductionmentioning

confidence: 99%

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NeoAPACHE Study Protocol Ii. Relationship Between Radiographic Pulmonary Area and Pulmonary Hypertension, Mortality, and Hernia Recurrence in Newborns With CDH.

Amodeo

Pesenti

Raffaeli

et al. 2021

Preprint

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To investigate the relationship between radiographic lung area and systolic pulmonary artery pressure (sPAP) on the first day of life, mortality, and hernia recurrence during the first year of life in infants with a congenital diaphragmatic hernia (CDH). Retrospective cohort study on 77 CDH newborns. Lung area was calculated by tracing the lung’s perimeter, excluding mediastinal structures and herniated organs, on the preoperative chest X-ray performed within 24 hours after birth. Echocardiographic sPAP value, deaths, and recurrence cases were recorded. Logistic and linear regression analyses were performed. Deceased infants showed lower areas and higher sPAP values. One cm2 of rising in the total, ipsilateral, and contralateral area was associated with a 22%, 43%, and 24% reduction in mortality risk. sPAP values showed a decreasing trend at birth, with a maximum of 1.84 mmHg reduction per unitary increment in the ipsilateral area. Recurrence patients showed lower areas, with recurrence risk decreasing by 14% and 29% per unit increment of the total and ipsilateral area.In CDH patients, lung area at birth reflects impaired lung development and defect size, being associated with increased sPAP values, mortality, and recurrence risk.Clinical Trial Registration: The trial was registered at ClinicalTrials.gov with identifier NCT04396028.

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Section: Discussionsupporting

confidence: 83%

“…The radiographic assessment's reproducibility has already been demonstrated in the primary analysis, using the Bland Altman plot and calculating the Pearson Correlation index 15 .…”

Section: Discussionmentioning

confidence: 99%

Section: Subjectsmentioning

confidence: 99%

Section: Assessment Of Radiographic Pulmonary Areamentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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NeoAPACHE Study Protocol Ii. Relationship Between Radiographic Pulmonary Area and Pulmonary Hypertension, Mortality, and Hernia Recurrence in Newborns With CDH.

Amodeo

Pesenti

Raffaeli

et al. 2021

Preprint

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Fetal endoscopic tracheal occlusion for congenital diaphragmatic hernia: systematic review and meta‐analysis

Chen

Xie

et al. 2023

Ultrasound in Obstet & Gyne

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What are the novel findings of this work?There is an ongoing debate regarding whether the impact of fetal endoscopic tracheal occlusion (FETO) varies in severe and moderate congenital diaphragmatic hernia (CDH). We demonstrate that FETO is associated with a reduction in mortality, rate of pulmonary hypertension and use of extracorporeal membrane oxygenation (ECMO) in severe CDH, but reduces only mortality in moderate CDH. In addition, FETO is associated with late preterm birth (but not extreme prematurity) regardless of CDH severity or timing of FETO. What are the clinical implications of this work?FETO should be recommended primarily for severe CDH to reduce mortality, risk of pulmonary hypertension and ECMO usage. Patients should be informed regarding the increased risk of late prematurity but not of extreme prematurity. Further evaluation is warranted to clarify the risk/benefit ratio of FETO in moderate CDH.

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The role of magnetic resonance imaging in the diagnosis and prognostic evaluation of fetuses with congenital diaphragmatic hernia

et al. 2022

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In recent years, magnetic resonance imaging (MRI) has largely increased our knowledge and predictive accuracy of congenital diaphragmatic hernia (CDH) in the fetus. Thanks to its technical advantages, better anatomical definition, and superiority in fetal lung volume estimation, fetal MRI has been demonstrated to be superior to 2D and 3D ultrasound alone in CDH diagnosis and outcome prediction. This is of crucial importance for prenatal counseling, risk stratification, and decision-making approach. Furthermore, several quantitative and qualitative parameters can be evaluated simultaneously, which have been associated with survival, postnatal course severity, and long-term morbidity.Conclusion: Fetal MRI will further strengthen its role in the near future, but it is necessary to reach a consensus on indications, methodology, and data interpretation. In addition, it is required data integration from different imaging modalities and clinical courses, especially for predicting postnatal pulmonary hypertension. This would lead to a comprehensive prognostic assessment. What is Known:• MRI plays a key role in evaluating the fetal lung in patients with CDH.• Prognostic assessment of CDH is challenging, and advanced imaging is crucial for a complete prenatal assessment and counseling. What is New:• Fetal MRI has strengthened its role over ultrasound due to its technical advantages, better anatomical definition, superior fetal lung volume estimation, and outcome prediction.• Imaging and clinical data integration is the most desirable strategy and may provide new MRI applications and future research opportunities.

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The NeoAPACHE Study Protocol I: Assessment of the Radiographic Pulmonary Area and Long-Term Respiratory Function in Newborns With Congenital Diaphragmatic Hernia

Abstract: Clinical Trial Registration: This trial was registered at ClinicalTrials.gov with the identifier NCT04396028.

Cited by 7 publications

References 31 publications

NeoAPACHE Study Protocol Ii. Relationship Between Radiographic Pulmonary Area and Pulmonary Hypertension, Mortality, and Hernia Recurrence in Newborns With CDH.

NeoAPACHE Study Protocol Ii. Relationship Between Radiographic Pulmonary Area and Pulmonary Hypertension, Mortality, and Hernia Recurrence in Newborns With CDH.

Fetal endoscopic tracheal occlusion for congenital diaphragmatic hernia: systematic review and meta‐analysis

The role of magnetic resonance imaging in the diagnosis and prognostic evaluation of fetuses with congenital diaphragmatic hernia

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