Elsevier

Journal of Pediatric Surgery

Volume 48, Issue 9, September 2013, Pages 1831-1836
Journal of Pediatric Surgery

Original Article
Outcome of CDH infants following fetoscopic tracheal occlusion — influence of premature delivery,☆☆

https://doi.org/10.1016/j.jpedsurg.2013.01.049Get rights and content

Abstract

Purpose

To evaluate the mortality and morbidity of infants with congenital diaphragmatic hernia who had undergone fetal endoscopic tracheal occlusion (FETO) and whether this was influenced by premature birth.

Methods

The gestational age at delivery, lung–head ratio (LHR) pre and post FETO, neonatal outcomes, and respiratory, gastro-intestinal, neurological, surgical, and musculoskeletal problems at follow up of consecutive infants who had undergone FETO were determined. Elective reversal of FETO was planned at 34 weeks of gestation.

Results

The survival rate of the 61 FETO infants was 48%, with 84% delivered prematurely. Thirty-one delivered < 35 weeks of gestation. Their survival rate was 18%. Twenty-three of 24 infants who had emergency balloon removal were born < 35 weeks of gestation. Survival was related to gestational age at delivery (OR 0.55, 95% CI 0.420, 0.77, p < 0.001) and the duration of FETO (OR 0.73, 95% CI 0.59, 0.91, p < 0.005). Infants born prior to 35 weeks of gestation compared to those born at  35 weeks required a longer duration of ventilation (median 45 days versus 12 days, p < 0.001), and a greater proportion had surgery for gastro-oesophageal reflux (50% versus 9%, p = 0.011).

Conclusion

These results emphasize the need to reduce premature delivery following FETO.

Section snippets

Materials and methods

A retrospective review was undertaken of all infants with CDH without other serious congenital anomalies born at King's College Hospital (KCH) NHS Foundation Trust who had undergone FETO during a six-year period from 2004 to 2009. Infants were identified from the neonatal and surgical databases. FETO was performed by placing a thin walled flexible Teflon cannula loaded with a custom designed pyramidal trocar into the amniotic cavity through the abdominal and uterine walls and directed towards

Results

Sixty-one CDH infants who were delivered at KCH in the six year period underwent FETO (Table 1), 84% delivered prematurely. There were no survivors born prior to 33 weeks of gestational age (Table 2). In 37 cases the balloon was removed electively, 18 of the 37 infants delivered in the subsequent week. In 24 cases the balloon was removed as an emergency procedure, in 23 cases delivery occurred before 35 weeks of gestation. None of the infants underwent an EXIT procedure. Overall, the survival

Discussion

We have demonstrated that the majority of CDH infants who had undergone FETO delivered prematurely and survival in those born prematurely compared to those born at term was significantly lower, particularly if delivery was prior to 35 weeks of gestation. The influence of premature delivery on survival rates of CDH infants then is similar to that reported in “non FETO” CDH infants [7], [8]. FETO, however, is only performed in fetuses predicted to have a poor prognosis. The LHR prior to the FETO

Acknowledgment

We thank Mrs Deirdre Gibbons for secretarial assistance.

References (20)

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Conflict of interest: No conflict of interest.

☆☆

Research and project support: Dr Kamal Ali is supported by the King's College Hospital Research Initiative Grant. Professor Anne Greenough is an NIHR Senior Investigator.

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