Maternal hyperoxygenation test in fetuses undergoing FETO for severe isolated congenital diaphragmatic hernia.
OBJECTIVE
To predict neonatal survival and pulmonary hypertension by measurement of fetal pulmonary artery reactivity to maternal hyperoxygenation in fetuses with severe congenital diaphragmatic hernia treated by fetoscopic endoluminal tracheal occlusion (FETO).


METHODS
Thirty-eight fetuses underwent FETO at around 28 weeks' gestation and the balloon was removed at 34 weeks in most cases. We performed a hyperoxygenation test and measured the lung-to-head ratio of each fetus before and after each procedure. Outcome measures were neonatal survival, occurrence of pulmonary hypertension and its response to inhaled nitric oxide (iNO).


RESULTS
Fetuses that survived had a larger increase in lung size and decrease of resistance in the first branch of the main pulmonary artery than did those that died. Both measures were also predictive of pulmonary hypertension unresponsive to iNO. The hyperoxygenation test and lung-to-head ratio were both best predictive for neonatal survival when measured following removal of the balloon (P < 0.002). Discriminant analysis confirmed that these two parameters are independent predictors of outcome.


CONCLUSIONS
In fetuses undergoing FETO, pulmonary vascular reactivity in relation to oxygen and lung size are independent predictors of neonatal survival and pulmonary hypertension. The hyperoxygenation test merits further study in expectantly managed cases.
Done
E
E
Department of Obstetrics and Gynaecology, Division of Woman and Child, University Hospitals Leuven, Leuven, Belgium.
Allegaert
K
K
Lewi
P
P
Jani
J
J
Gucciardo
L
L
Van Mieghem
T
T
Gratacos
E
E
Devlieger
R
R
Van Schoubroeck
D
D
Deprest
J
J
D021721:Balloon Occlusion / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D005260:Female; D005315:Fetal Diseases / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy; D005332:Fetoscopy / Q000379:methods*; D005865:Gestational Age; D006548:Hernia, Diaphragmatic / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D006976:Hypertension, Pulmonary / Q000000981:diagnostic imaging* / Q000209:etiology; D007231:Infant, Newborn; D008168:Lung / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000196:embryology; D008297:Male; D009569:Nitric Oxide / Q000378:metabolism; D011247:Pregnancy; D011256:Pregnancy Outcome; D011300:Preoperative Care; D011446:Prospective Studies; D011651:Pulmonary Artery / Q000000981:diagnostic imaging; D016019:Survival Analysis; D018608:Ultrasonography, Doppler; D014655:Vascular Resistance / Q000502:physiology
D009569:Nitric Oxide