Congenital primary hydrothorax: effect of thoracoamniotic shunting on neonatal clinical outcome.
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.
Bianchi
Silvia
S
Neonatal Intensive Care Unit, Department of Obstetrics and Gynaecology, V. Buzzi Children's Hospital, ICP, Milan, Italy. silvia.bianchi72@libero.it
Lista
Gianluca
G
Castoldi
Francesca
F
Rustico
Mariangela
M
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