Liver position in fetal congenital diaphragmatic hernia retains a prognostic value in the era of lung-protective strategy
| Autor: | Tomoo Nakamura, Nobuyuki Morikawa, Kyoko Kashima, Toshiro Honna, Tatsuo Kuroda, Yushi Itoh, Satoshi Nakagawa, Satoshi Hayashi, Yoshihiro Kitano, Haruhiko Sago, Naoki Shimizu |
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| Rok vydání: | 2005 |
| Předmět: |
medicine.medical_specialty
medicine.medical_treatment Diaphragmatic breathing Prenatal diagnosis Mean airway pressure Extracorporeal Membrane Oxygenation Fetus Fraction of inspired oxygen Prenatal Diagnosis Extracorporeal membrane oxygenation Medicine Humans Hernia Retrospective Studies Hernia Diaphragmatic medicine.diagnostic_test business.industry Congenital diaphragmatic hernia Magnetic resonance imaging General Medicine medicine.disease Prognosis Magnetic Resonance Imaging Survival Analysis Surgery Chest Wall Oscillation Liver Anesthesia Pediatrics Perinatology and Child Health business Hernias Diaphragmatic Congenital |
| Zdroj: | Journal of pediatric surgery. 40(12) |
| ISSN: | 1531-5037 |
| Popis: | Background/Purpose The aims of this study were to analyze the outcomes of fetuses with congenital diaphragmatic hernia (CDH) treated by a lung-protective strategy using high-frequency oscillatory ventilation (HFOV) in a single center with a perinatology service and extracorporeal membrane oxygenation (ECMO) capability and to define the natural history of CDH in the era of lung-protective ventilation. Methods A retrospective chart review of 30 neonates with CDH seen between April 2002 and October 2004 was conducted. All fetuses with a prenatal diagnosis were evaluated by fetal magnetic resonance imaging to define the liver position, and those with a significant volume of the liver in the chest were regarded as liver-up. Patients were managed by a lung-protective strategy using pressure-limited (maximum mean airway pressure [MAP], 18 cm H 2 O) HFOV. The patients were initially placed on HFOV with a fraction of inspired oxygen (Fio 2 ) of 1.0 and a MAP of 12 cm H 2 O. Hypercapnea and preductal saturation as low as 85% were accepted. Inhaled nitric oxide and ECMO were introduced when the baby could not be oxygenated with a MAP of 18 cm H 2 O. Results Twenty-six neonates (22 inborns with prenatal diagnosis and 4 outborns) were treated with this protocol. Four cases were not treated or died in utero because of severe associated anomalies. Thirteen of the 14 liver-down cases survived without ECMO and were discharged home (93% survival). On the contrary, 4 of 12 liver-up cases survived (33% survival). ECMO was required for initial stabilization in 5 cases with 1 survivor. Conclusions Liver-down CDH babies have a good chance for survival without ECMO by a planned delivery and the lung-protective strategy using HFOV. Liver herniation demonstrated by prenatal magnetic resonance imaging retains a poor prognostic value even with this approach. |
| Databáze: | OpenAIRE |
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