Congenital diaphragmatic hernia-influence of fetoscopic tracheal occlusion on outcomes and predictors of survival.
The morbidity of infants with congenital diaphragmatic hernia (CDH) who had undergone foetal endoscopic tracheal occlusion (FETO) to those who had not was compared and predictors of survival regardless of antenatal intervention were identified. FETO was undertaken on the basis of the lung to head ratio or the position of the liver. A retrospective review of the records of 78 CDH infants was undertaken to determine the lung-head ratio (LHR) at referral and prior to birth, maximum oxygen saturation in the labour suite and neonatal outcomes. The 43 FETO infants were born earlier (mean 34 versus 38 weeks) (p < 0.001). They had a lower mean LHR at referral (0.65 versus 1.24) (p < 0.001) but not prior to birth and did not have a higher mortality than the 35 non-FETO infants. The FETO infants required significantly longer durations of ventilation (median: 15 versus 6 days) and supplementary oxygen (28 versus 8 days) and hospital stay (29 versus 16 days). Overall, the best predictor of survival was the OI in the first 24 h.


CONCLUSIONS
The FETO group had increased morbidity, but not mortality. The lowest oxygenation index in the first 24 h was the best predictor of survival regardless of antenatal intervention.


BACKGROUND
• Randomised controlled trials have demonstrated that foetal endotracheal occlusion (FETO) in high risk infants with congenital diaphragmatic hernia is associated with a higher survival rate. • Mortality is greater in foetuses who underwent FETO and delivered prior to 35 weeks of gestation. What is New: • Infants who had undergone FETO compared to those who had not had significantly longer durations of mechanical ventilation, supplementary oxygen and hospital stay. • Regardless of antenatal intervention, the lowest oxygenation index in the first 24 h was the best predictor of survival.
Neonatal Intensive Care Unit, King's College Hospital, 4th Floor Golden Jubilee Wing, Denmark Hill, London, SE5 9RS, UK.
Kamal
K
Ali
Neonatal Intensive Care Unit, King's College Hospital, 4th Floor Golden Jubilee Wing, Denmark Hill, London, SE5 9RS, UK.
Perraju
P
Bendapudi
Neonatal Intensive Care Unit, King's College Hospital, 4th Floor Golden Jubilee Wing, Denmark Hill, London, SE5 9RS, UK.
Satyamaanasa
S
Polubothu
Division of Asthma, Allergy and Lung Biology, MRC and Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, London, UK.
Gwendolyn
G
Andradi
Division of Health and Social Care Research, Faculty of Life Sciences and Medicine, King's College London, London, UK.
Mercy
M
Ofuya
Division of Health and Social Care Research, Faculty of Life Sciences and Medicine, King's College London, London, UK.|NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK.
Janet
J
Peacock
Neonatal Intensive Care Unit, King's College Hospital, 4th Floor Golden Jubilee Wing, Denmark Hill, London, SE5 9RS, UK.
Ann
A
Hickey
Department of Paediatric Surgery, King's College Hospital, London, UK.
Mark
M
Davenport
Department of Fetal Medicine, King's College Hospital, London, UK.
Kypros
K
Nicolaides
Neonatal Intensive Care Unit, King's College Hospital, 4th Floor Golden Jubilee Wing, Denmark Hill, London, SE5 9RS, UK. anne.greenough@kcl.ac.uk.|Division of Asthma, Allergy and Lung Biology, MRC and Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, London, UK. anne.greenough@kcl.ac.uk.|NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK. anne.greenough@kcl.ac.uk.
Anne
http://orcid.org/0000-0002-8672-5349
A
Greenough
D000328:Adult; D021721:Balloon Occlusion / Q000009:adverse effects / Q000379:methods*; D001724:Birth Weight; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D005260:Female; D005332:Fetoscopy / Q000379:methods*; D005865:Gestational Age; D065630:Hernias, Diaphragmatic, Congenital / Q000401:mortality / Q000601:surgery*; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D008297:Male; D011247:Pregnancy; D012372:ROC Curve; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D014132:Trachea / Q000196:embryology; D016896:Treatment Outcome
Congenital diaphragmatic hernia; FETO; Oxygenation index; Prediction of mortality