title: [Tracheal occlusion for fetuses with severe isolated left-sided diaphragmatic hernia: a nonrandomized controlled experimental study].
abstract: OBJECTIVE
  To compare postnatal survival to hospital discharge of fetuses with severe isolated left-sided congenital diaphragmatic hernia, who underwent tracheal occlusion, with that of nonrandomized contemporaneous controls.
  
  
  METHODS
  Experimental nonrandomized controlled study, performed from April 2007 to September 2011. Fetuses with severe isolated left-sided congenital diaphragmatic hernia with liver herniation into the chest and lung area-to-head circumference ratio <1.0, who underwent tracheal occlusion (study group) or expectant management (non-randomized contemporaneous controls), were compared in terms of lung area-to-head circumference ratio and observed/expected lung area-to-head circumference ratio (observed/expected lung area-to-head circumference ratio) at the time of diagnosis, gestational age at birth, and survival to hospital discharge. Modifications in lung area-to-head circumference ratio and o/e lung area-to-head circumference ratio after tracheal occlusion were also analyzed. Fisher's exact test, Mann-Whitney's or Wilcoxon's tests were used for the comparisons.
  
  
  RESULTS
  There were no significant differences between the Study Group (TO=28) and Controls (n=13) in terms of the lung area-to-head circumference ratio (p=0.709) and the observed/expected lung area-to-head circumference ratio (p=0.5) at the time of diagnosis and gestational age at birth (p=0.146). The survival to hospital discharge was higher (p=0.012) in the tracheal occlusion group (10/28=35.7%) than in controls (0/13=0.0%). There was a significant increase in lung area-to-head circumference ratio (p<0.001) and observed/expected lung area-to-head circumference ratio (p<0.001) between the diagnosis of the congenital diaphragmatic hernia [lung area-to-head circumference ratio: 0.80 (0.40-0.94); observed/expected lung area-to-head circumference ratio: 27.0 (15.3-45.0)], and the day before retrieval of the balloon [lung area-to-head circumference ratio: 1.2 (0.50-1.80); observed/expected lung area-to-head circumference ratio: 40.0 (17.5-60.0)].
  
  
  CONCLUSIONS
  There was a significant improvement in the survival rate to hospital discharge of fetuses with severe isolated left-sided congenital diaphragmatic hernia, who underwent tracheal occlusion in comparison to nonrandomized contemporaneous controls.
authors.affiliation: Departamento de Obstetrícia e Ginecologia, Hospital da Mulher Professor Doutor José Aristodemo Pinotti, Centro de Atenção Integral à Saúde da Mulher, Universidade Estadual de Campinas, Campinas, SP, Brasil.
authors.forename: Cleisson Fábio Andrioli
authors.initials: CF
authors.lastname: Peralta
authors.forename: Lourenço
authors.initials: L
authors.lastname: Sbragia
authors.forename: João Renato
authors.initials: JR
authors.lastname: Bennini
authors.forename: Ricardo Carvalho
authors.initials: RC
authors.lastname: Cavalli
authors.forename: Monique Sampaio
authors.initials: MS
authors.lastname: Rousselet
authors.forename: Ricardo
authors.initials: R
authors.lastname: Barini
mesh_terms: D005260:Female; D005315:Fetal Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D006548:Hernia, Diaphragmatic / Q000000981:diagnostic imaging / Q000196:embryology / Q000601:surgery; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D011247:Pregnancy; D012720:Severity of Illness Index; D014132:Trachea / Q000601:surgery*; D014463:Ultrasonography