+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

Usefulness of lung-to-head ratio and intrapulmonary arterial Doppler in predicting neonatal morbidity in fetuses with congenital diaphragmatic hernia treated with fetoscopic tracheal occlusion



Usefulness of lung-to-head ratio and intrapulmonary arterial Doppler in predicting neonatal morbidity in fetuses with congenital diaphragmatic hernia treated with fetoscopic tracheal occlusion



Ultrasound in Obstetrics and Gynecology 41(1): 59-65



To explore the potential value of intrapulmonary artery Doppler velocimetry in predicting neonatal morbidity in fetuses with left-sided congenital diaphragmatic hernia (CDH) treated with fetoscopic tracheal occlusion (FETO). Observed/expected lung-to-head ratio (O/E-LHR), and intrapulmonary Doppler pulsatility index and peak early-diastolic reversed flow were evaluated within 24 h before FETO in a consecutive cohort of 51 fetuses with left-sided CDH at between 24 and 33 weeks' gestation. Lung Doppler parameters were converted into Z-scores and defined as abnormal if the pulsatility index had a Z-score of > 1.0 or the peak early-diastolic reversed flow had a Z-score of > 3.5. The association of O/E-LHR and Doppler velocimetry with neonatal outcome was assessed using multiple linear or logistic regression analysis adjusted for gestational age at birth. Among the 26 fetuses that survived, 18 (69.2%) had normal and eight (30.8%) had abnormal Doppler values. O/E-LHR was not associated with neonatal morbidity in surviving fetuses. Compared with the group with normal Doppler parameters, cases with abnormal intrapulmonary Doppler were associated with a significant increase in the duration of mechanical ventilation (average increase of 21.2 (95% CI, 9.99-32.5) days; P < 0.01), conventional ventilation (15.2 (95% CI, 7.43-23.0) days; P < 0.01), high-frequency ventilation (6.34 (95% CI, 0.69-11.99) days; P < 0.05), nitric oxide therapy (5.73 (95% CI, 0.60-10.9) days; P < 0.05), oxygen support (36.5 (95% CI, 16.3-56.7) days; P < 0.01), parenteral nutrition (19.1 (95% CI, 7.53-30.7) days; P < 0.01) and stay in neonatal intensive care unit (42.7 (95% CI, 22.9-62.6) days; P < 0.001), and with significantly higher rates of high-frequency ventilation (87.5 vs. 44.4%;P < 0.05), oxygen requirement at 28 days of age (75.0 vs. 11.1%; P < 0.01), gastroesophageal reflux (62.5 vs. 22.2%; P < 0.05) and tube feeding at discharge (37.5 vs. 5.56%; P < 0.05). As previously reported, O/E-LHR did not predict neonatal morbidity. In contrast, intrapulmonary artery Doppler evaluation was predictive of neonatal morbidity in CDH fetuses treated with FETO.

Please choose payment method:






(PDF emailed within 0-6 h: $19.90)

Accession: 056808655

Download citation: RISBibTeXText

PMID: 22689226

DOI: 10.1002/uog.11212


Related references

OC20.02: Evaluation of intrapulmonary Doppler in prediction of morbidity in fetuses with congenital diaphragmatic hernia treated with fetal endoscopic tracheal occlusion. Ultrasound in Obstetrics & Gynecology 36(S1): 37-37, 2010

Pulsed doppler evaluation of the intrapulmonary circulation after, fetoscopic tracheal occlusion in fetuses with severe congenital diaphragmatic hernia and association with clinical outcome.. 2007

Correction of congenital diaphragmatic hernia in utero IX: fetuses with poor prognosis (liver herniation and low lung-to-head ratio) can be saved by fetoscopic temporary tracheal occlusion. Journal of Pediatric Surgery 33(7): 1017-22; Discussion 1022-3, 1998

Predictors of neonatal morbidity in fetuses with severe isolated congenital diaphragmatic hernia undergoing fetoscopic tracheal occlusion. Ultrasound in Obstetrics and Gynecology 42(1): 77-83, 2013

Association between intrapulmonary arterial Doppler parameters and degree of lung growth as measured by lung-to-head ratio in fetuses with congenital diaphragmatic hernia. Ultrasound in Obstetrics and Gynecology 31(2): 164-170, 2008

OC15.05: Fetal intrapulmonary Doppler predicts severe neonatal pulmonary hypertension in fetuses with congenital diaphragmatic hernia treated with fetal endoscopic tracheal occlusion. Ultrasound in Obstetrics & Gynecology 38(S1): 29-29, 2011

OC08: Relative increase in lung volume in fetuses with congenital diaphragmatic hernia treated by fetoscopic endoluminal tracheal occlusion (FETO). Ultrasound in Obstetrics & Gynecology 28(4): 361-361, 2006

OP27.02: Prediction of neonatal outcome in 20 fetuses with severe left congenital diaphragmatic hernia submitted to percutaneous fetal tracheal occlusion by the lung-head ratio. Ultrasound in Obstetrics & Gynecology 36(S1): 131-131, 2010

Contribution of intrapulmonary artery Doppler to improve prediction of survival in fetuses with congenital diaphragmatic hernia treated with fetal endoscopic tracheal occlusion. Ultrasound in Obstetrics and Gynecology 35(5): 572-577, 2010

The lung-to-head ratio and fetoscopic temporary tracheal occlusion: prediction of survival in severe left congenital diaphragmatic hernia. Ultrasound in Obstetrics and Gynecology 21(3): 244-249, 2003

OC02.01: Association of lung perfusion with the lung to head ratio and intrapulmonary pulsed Doppler in fetuses with congenital diaphragmatic hernia. Ultrasound in Obstetrics & Gynecology 34(S1): 2-3, 2009

Reliability of the lung-to-head ratio in predicting outcome and neonatal ventilation parameters in fetuses with congenital diaphragmatic hernia. Ultrasound in Obstetrics and Gynecology 25(2): 112-118, 2005

OC221: Fractional moving blood volume as a predictor of survival in fetuses with severe congenital diaphragmatic hernia treated with fetoscopic tracheal occlusion. Ultrasound in Obstetrics & Gynecology 30(4): 435-435, 2007

Prophylactic use of the Arabin cervical pessary in fetuses with severe congenital diaphragmatic hernia treated by fetoscopic endoluminal tracheal occlusion (FETO): preliminary experience. Prenatal Diagnosis 36(1): 81-87, 2016

Neonatal tracheal changes following in utero fetoscopic balloon tracheal occlusion in severe congenital diaphragmatic hernia. Journal of Pediatric Surgery 45(4): 687-692, 2010