Tracheomegaly in infants with severe congenital diaphragmatic hernia treated with fetal endoluminal tracheal occlusion.
OBJECTIVE
To measure and evaluate the effects of tracheal dimensions on survival and ventilation in a large series of infants with congenital diaphragmatic hernia (CDH) treated antenatally with fetal endoluminal tracheal occlusion (FETO).


METHODS
Tracheal dimensions on chest radiograph (CR) were measured by 2 blinded radiologists. Survival, day 1 best oxygenation index and duration of ventilation, continuous positive airway pressure, and hospital stay were recorded. Survivors with a minimum 12-month follow-up were longitudinally compared for incidence of gastroesophageal reflux, chest infections, chest deformities, and hernia recurrence.


RESULTS
Seventy infants with CDH (41 who underwent FETO) were treated between 2004 and 2010. Hernia repair was performed in 26 infants without FETO (8 with patch repair) and 35 infants with FETO (26 with patch repair; P = .0015). Infants with FETO had a wider trachea than those without FETO at T1 (P < .0001) and between T1 and the carina (P < .0001). Tracheal diameter was similar in survivors and nonsurvivors in the FETO group. Tracheal size was not correlated with day 1 best oxygenation index in the FETO group (R2 = 0.17) or the non-FETO group (R2 = 0.07). There were no between-group differences in duration of mechanical ventilation (P = .30), continuous positive airway pressure (P = .20), or hospital stay (P = .30). In the longitudinal study, tracheal widths were larger on the last CR than on preoperative CR in patients without FETO (T1, P = .02; widest point, P = .001; carina, P = .0001), and for patients with FETO at the widest point (P < .0001) and at the carina (P < .0001), but not at T1 (P = .12). There were no differences in clinical variables between the FETO and non-FETO groups.


CONCLUSIONS
FETO has a significant impact on tracheal size of infants with CDH; however, tracheal size does not affect survival or the requirement for early respiratory support.
Department of Pediatric Surgery, King's College Hospital, London, United Kingdom.
Augusto
A
Zani
Department of Radiology, King's College Hospital, London, United Kingdom.
Maria
M
Sellars
Department of Radiology, King's College Hospital, London, United Kingdom.
Pamela
P
Allen
Department of Pediatric Surgery, King's College Hospital, London, United Kingdom.
Athanasios
A
Tyraskis
Harris Birthright Research Center for Fetal Medicine, King's College Hospital, London, United Kingdom.
Kypros
K
Nicolaides
Division of Asthma, Allergy, and Lung Biology, King's College London, London, United Kingdom.
Anne
A
Greenough
Department of Pediatric Surgery, King's College Hospital, London, United Kingdom.
Shailesh
S
Patel
Department of Pediatric Surgery, King's College Hospital, London, United Kingdom.
Mark
M
Davenport
Department of Pediatric Surgery, King's College Hospital, London, United Kingdom. Electronic address: niyi.adeajayi@gmail.com.
Niyi
N
Ade-Ajayi
D000402:Airway Obstruction / Q000175:diagnosis / Q000209:etiology; D021721:Balloon Occlusion / Q000009:adverse effects* / Q000379:methods; D003430:Cross-Sectional Studies; D005260:Female; D005332:Fetoscopy / Q000009:adverse effects* / Q000379:methods; D005500:Follow-Up Studies; D006548:Hernia, Diaphragmatic / Q000000981:diagnostic imaging / Q000628:therapy; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008137:Longitudinal Studies; D008297:Male; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000628:therapy*; D011256:Pregnancy Outcome; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D014132:Trachea / Q000000981:diagnostic imaging / Q000503:physiopathology*; D016896:Treatment Outcome; D016216:Ultrasonography, Prenatal / Q000379:methods