Influence of fetal stabilization on postnatal status of patients with congenital diaphragmatic hernia.
OBJECTIVE
Fetal stabilization (FS) is a way to decrease stresses to the fetus during the perinatal period to control persistent pulmonary hypertension in neonates (PPHN). Although FS in congenital diaphragmatic hernia (CDH) patients has been reported, the effect of FS has not been evaluated sufficiently. The present study retrospectively evaluated influences of FS on the postnatal status of CDH patients.


METHODS
Twenty-three cases of prenatally diagnosed CDH which were treated after birth in our institution from April 1998 to March 2010 were reviewed. From April 1998 to May 2007, FS was performed by administration of fentanyl and midazolam to the mother before subsequent cesarean section (FS group, n = 10). Beginning from June 2007, FS was discontinued (non-FS, n = 13).


RESULTS
At the first postnatal estimation, flow pattern of the ductus arteriosus had no difference between two groups. The oxygenation index of the FS group was significantly higher than that in the non-FS group (p = 0.045). Only the non-FS group had correlations between estimated standardized lung volume (% lung volume) and alveolar-arterial oxygen tension difference (p = 0.022), and between % lung volume and the oxygenation index (p = 0.0037).


CONCLUSIONS
During the period immediately after birth, FS had no obvious therapeutic effect on PPHN, and had a negative impact on respiratory status.
Terui
Keita
K
Department of Pediatric Surgery, Graduate School of Medicine, Chiba University, Chiba, 260-8677, Japan. kta@cc.rim.or.jp
Omoto
Akiko
A
Osada
Hisao
H
Hishiki
Tomoro
T
Saito
Takeshi
T
Sato
Yoshiharu
Y
Mitsunaga
Tetsuya
T
Yoshida
Hideo
H
D018686:Anesthetics, Intravenous; D002585:Cesarean Section; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage; D005315:Fetal Diseases; D005316:Fetal Distress / Q000209:etiology / Q000517:prevention & control*; D005323:Fetal Monitoring / Q000379:methods*; D005500:Follow-Up Studies; D006548:Hernia, Diaphragmatic / Q000150:complications; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications; D008176:Lung Volume Measurements / Q000379:methods; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008874:Midazolam / Q000008:administration & dosage; D011247:Pregnancy; D011296:Prenatal Diagnosis; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
D018686:Anesthetics, Intravenous; D008874:Midazolam; D005283:Fentanyl