title: Fetal stabilization for antenatally diagnosed diaphragmatic hernia.
abstract: OBJECTIVE
  Infants with congenital diaphragmatic hernia have pulmonary hypoplasia resulting in persistent pulmonary hypertension of neonates (PPHN), which is the main contributor to both high mortality and morbidity. The pulmonary artery bed in patients with congenital diaphragmatic hernia (CDH) is underdeveloped and is very sensitive to slight stimuli. It is, therefore, vital to avoid any factors that might increase pulmonary vascular resistance during the perinatal treatment of these patients. Recently, fetal anesthesia for perinatal stabilization in patients with CDH has been reported. However, the efficacy of this method remains controversial. The aim of this study is to analyze the benefits of fetal stabilization using fetal anesthesia in patients with CDH.
  
  
  METHODS
  The authors have seen 9 cases of antenatally diagnosed CDH and attempted fetal stabilization. The indication for fetal stabilization was a lung thoracic ratio of less than 0.2, without any severe associated anomalies. The protocol for fetal stabilization was (1) monitoring the fetal respiratory movement and heart beat by ultrasonography, (2) the administration of morphine (20 to 30 mg) and diazepam (5 mg) to the mother, (3) the confirmation of any interruptions in fetal movement followed by a cesarean section, (4) pancuronimum (0.5 mg) was given through the umbilical vessels, (5) intubation before clamping of the umbilical cord, and (6) high-frequency oscillatory ventilation (HFO) without bagging.
  
  
  RESULTS
  The lung-thratic ratio (LTR) was between 0.06 to 0.17 (average, 0.10+/-0.04). Operation was performed in 7 of 9 patients at between 2.5 and 27 hours after birth. The overall survival rate was 66.7% (6 of 9). All of the patients who underwent operation within 5 hours after birth survived.
  
  
  CONCLUSIONS
  Perinatal stabilization using fetal anesthesia was found to be effective in preventing PPHN and shortening the period of preoperative stabilization. It also improved the survival rate of patients with severe CDH.
authors.affiliation: Department of Pediatric Surgery, Faculty of Medicine, Kyushu University, Fukuoka, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Suita
authors.forename: T
authors.initials: T
authors.lastname: Taguchi
authors.forename: T
authors.initials: T
authors.lastname: Yamanouchi
authors.forename: K
authors.initials: K
authors.lastname: Masumoto
authors.forename: K
authors.initials: K
authors.lastname: Ogita
authors.forename: M
authors.initials: M
authors.lastname: Nakamura
authors.forename: H
authors.initials: H
authors.lastname: Nakayama
authors.forename: T
authors.initials: T
authors.lastname: Hara
authors.forename: K
authors.initials: K
authors.lastname: Tsukimori
authors.forename: H
authors.initials: H
authors.lastname: Nakano
authors.forename: T
authors.initials: T
authors.lastname: Kanna
authors.forename: S
authors.initials: S
authors.lastname: Takahashi
mesh_terms: D005260:Female; D005316:Fetal Distress / Q000517:prevention & control*; D005323:Fetal Monitoring / Q000379:methods; D005500:Follow-Up Studies; D005865:Gestational Age; D006548:Hernia, Diaphragmatic / Q000000981:diagnostic imaging / Q000601:surgery*; D065630:Hernias, Diaphragmatic, Congenital; D006612:High-Frequency Ventilation; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D009569:Nitric Oxide / Q000008:administration & dosage*; D010547:Persistent Fetal Circulation Syndrome / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D011247:Pregnancy; D015996:Survival Rate; D016896:Treatment Outcome; D016216:Ultrasonography, Prenatal
chemical_list: D009569:Nitric Oxide