Original ArticleOutcome of CDH infants following fetoscopic tracheal occlusion — influence of premature delivery☆,☆☆
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.
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Fetoscopic endoluminal tracheal occlusion vs expectant management for fetuses with severe left-sided congenital diaphragmatic hernia
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Prognostic value of the oxygenation index to predict survival and timing of surgery in infants with congenital diaphragmatic hernia
2019, Journal of Pediatric SurgeryCitation Excerpt :Between January 2009 and August 2013, fetuses were eligible for FETO if they had a left CDH and LHR ≤ 1.0 or a right-sided CDH with the liver in the chest [18,19]. Between August 2013 and December 2015, infants with moderate risk (Observed/Expected, O/E LHR 25%–45%) and severe risk (O/E LHR < 25%) left sided CDH were offered tracheal occlusion through randomization into the Tracheal Occlusion To Accelerate Lung growth (TOTAL) trial [20,21]. All infants were intubated at birth.
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2019, Materials Science and Engineering CCitation Excerpt :Congenital Diaphragmatic Hernia (CDH) is a severe fetal anomaly characterized by incomplete formation of diaphragm and herniation of abdominal organs in the thoracic cavity. The protrusion of abdominal viscera impairs normal pulmonary development and leads, as main post-natal consequences, to lung hypoplasia and pulmonary hypertension [1–3]. The reported incidence of CDH ranges from 1 in 2500 to 1 in 4000 live births [4].
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2024, Archives of Disease in Childhood: Fetal and Neonatal EditionSurvival in very preterm infants with congenital diaphragmatic hernia and association with prenatal imaging markers: A retrospective cohort study
2023, BJOG: An International Journal of Obstetrics and Gynaecology
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Conflict of interest: No conflict of interest.
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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.