title: Congenital primary hydrothorax: effect of thoracoamniotic shunting on neonatal clinical outcome.
abstract: BACKGROUND
  Spontaneous regression in the foetal period has been described for congenital hydrothorax. Hydrothorax may become larger and bilateral with hydrops and pulmonary hypoplasia. Prenatal thoracentesis and thoracoamniotic shunting of massive hydrothorax are indicated to decrease perinatal morbidity. In the neonatal period, persistent hydrothorax may require intensive care.
  
  
  OBJECTIVE
  To investigate neonatal outcome after thoracoamniotic shunting for congenital primary hydrothorax with hydrops/ polydramnios.
  
  
  METHODS
  Retrospective study on the postnatal management of a cohort of 28 congenital primary hydrothorax cases after thoracoamniotic shunting (January 2000-August 2005).
  
  
  RESULTS
  Congenital hydrotorax without major structural anomalies complicated by polidramnios and/or hydrops<34 weeks' gestation were the criteria accepted for thoracoamniotic shunting. There were neither pregnancy terminations nor utero deaths. Although 64% of cases were complicated by severe neonatal respiratory insufficiency, neonatal mortality rate was low (21.4%) if compared with literature. Univariate analysis identified 'birth at gestational age (GA)<35 weeks' and 'time between prenatal shunting and birth' as predictive factors for needing of ventilation. Multivariate analysis identified 'birth at GA<35 weeks' as the only independent predictor for needing ventilation. (OR=0.08, CI 95%=0.01-0.96, p=0.046). No risk factors for death or adverse neurological outcomes were reported.
  
  
  CONCLUSIONS
  Congenital hydrothorax although corrected by thoracoamniotic shunting is complicated by severe respiratory distress. The neonatal outcome may be improved limiting degree of prematurity; the presence of thoracoamniotic shunt is not per se an indication of premature birth, at least until GA>35 weeks and adequate pulmonary maturity is reached.
authors.affiliation: Neonatal Intensive Care Unit, Department of Obstetrics and Gynaecology, V. Buzzi Children's Hospital, ICP, Milan, Italy. silvia.bianchi72@libero.it
authors.forename: Silvia
authors.initials: S
authors.lastname: Bianchi
authors.forename: Gianluca
authors.initials: G
authors.lastname: Lista
authors.forename: Francesca
authors.initials: F
authors.lastname: Castoldi
authors.forename: Mariangela
authors.initials: M
authors.lastname: Rustico
mesh_terms: D005260:Female; D005325:Fetal Organ Maturity; D005332:Fetoscopy; D005865:Gestational Age; D006801:Humans; D006876:Hydrothorax / Q000151:congenital* / Q000601:surgery*; D007231:Infant, Newborn; D015931:Intensive Care, Neonatal; D008297:Male; D011247:Pregnancy; D047928:Premature Birth; D012121:Respiration, Artificial; D012189:Retrospective Studies; D047929:Term Birth; D019616:Thoracic Surgical Procedures