title: Prematurity and fetal lung response after tracheal occlusion in fetuses with severe congenital diaphragmatic hernia.
abstract: OBJECTIVE
  To evaluate the independent association of fetal pulmonary response and prematurity to postnatal outcomes after fetal tracheal occlusion for congenital diaphragmatic hernia.
  
  
  METHODS
  Fetal pulmonary response, prematurity (<37 weeks at delivery) and extreme prematurity (<32 weeks at delivery) were evaluated and compared between survivors and non-survivors at 6 months of life. Multivariable analysis was conducted with generalized linear mixed models for variables significantly associated with survival in univariate analysis.
  
  
  RESULTS
  Eighty-four infants were included, of whom 40 survived (47.6%) and 44 died (52.4%). Univariate analysis demonstrated that survival was associated with greater lung response (p=0.006), and the absence of extreme preterm delivery (p=0.044). In multivariable analysis, greater pulmonary response after FETO was an independent predictor of survival (aOR 1.87, 95% CI 1.08-3.33, p=0.023), whereas the presence of extreme prematurity was not statistically associated with mortality after controlling for fetal pulmonary response (aOR 0.52, 95% CI 0.12-2.30, p=0.367).
  
  
  CONCLUSIONS
  Fetal pulmonary response after FETO is the most important factor associated with survival, independently from the gestational age at delivery.
authors.affiliation: a Department of Obstetrics and Gynecology , Texas Children's Fetal Center, Baylor College of Medicine , Houston , TX , USA .|b Service De Gynécologie Obstétrique, CMCO - HUS, Hôpitaux Universitaires De Strasbourg , Strasbourg , France .
authors.forename: Nicolas
authors.initials: N
authors.lastname: Sananes
authors.affiliation: c Fetal Surgery Program, Hospital Universitari Vall D'hebron , Barcelona , Spain .
authors.forename: Carlota
authors.initials: C
authors.lastname: Rodo
authors.affiliation: c Fetal Surgery Program, Hospital Universitari Vall D'hebron , Barcelona , Spain .
authors.forename: Jose Luis
authors.initials: JL
authors.lastname: Peiro
authors.affiliation: a Department of Obstetrics and Gynecology , Texas Children's Fetal Center, Baylor College of Medicine , Houston , TX , USA .
authors.forename: Ingrid Schwach Werneck
authors.initials: IS
authors.lastname: Britto
authors.affiliation: a Department of Obstetrics and Gynecology , Texas Children's Fetal Center, Baylor College of Medicine , Houston , TX , USA .
authors.forename: Haleh
authors.initials: H
authors.lastname: Sangi-Haghpeykar
authors.affiliation: b Service De Gynécologie Obstétrique, CMCO - HUS, Hôpitaux Universitaires De Strasbourg , Strasbourg , France .
authors.forename: Romain
authors.initials: R
authors.lastname: Favre
authors.affiliation: b Service De Gynécologie Obstétrique, CMCO - HUS, Hôpitaux Universitaires De Strasbourg , Strasbourg , France .
authors.forename: Arnaud
authors.initials: A
authors.lastname: Joal
authors.affiliation: b Service De Gynécologie Obstétrique, CMCO - HUS, Hôpitaux Universitaires De Strasbourg , Strasbourg , France .
authors.forename: Adrien
authors.initials: A
authors.lastname: Gaudineau
authors.affiliation: d Department of Pediatric Surgery and.
authors.forename: Marcos Marques da
authors.initials: MM
authors.lastname: Silva
authors.affiliation: d Department of Pediatric Surgery and.
authors.forename: Uenis
authors.initials: U
authors.lastname: Tannuri
authors.affiliation: e Department of Obstetrics and Gynecology , Faculdade De Medicina, Universidade De Sao Paulo , Sao Paulo , Brazil.
authors.forename: Marcelo
authors.initials: M
authors.lastname: Zugaib
authors.affiliation: b Service De Gynécologie Obstétrique, CMCO - HUS, Hôpitaux Universitaires De Strasbourg , Strasbourg , France .
authors.forename: Elena
authors.initials: E
authors.lastname: Carreras
authors.affiliation: a Department of Obstetrics and Gynecology , Texas Children's Fetal Center, Baylor College of Medicine , Houston , TX , USA .|e Department of Obstetrics and Gynecology , Faculdade De Medicina, Universidade De Sao Paulo , Sao Paulo , Brazil.
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Ruano
mesh_terms: D000704:Analysis of Variance; D005315:Fetal Diseases / Q000401:mortality / Q000601:surgery*; D005332:Fetoscopy / Q000379:methods* / Q000401:mortality; D005865:Gestational Age; D065630:Hernias, Diaphragmatic, Congenital / Q000196:embryology / Q000401:mortality / Q000601:surgery*; D006801:Humans; D062071:Infant, Extremely Premature; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000401:mortality / Q000601:surgery*; D008168:Lung / Q000196:embryology / Q000254:growth & development*; D012189:Retrospective Studies; D015996:Survival Rate; D014132:Trachea / Q000196:embryology
keywords: Congenital diaphragmatic hernia; fetal lung; fetal surgery; fetoscopy; lung-to-head ratio; prematurity