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Prediction of Neonatal Respiratory Function and Pulmonary Hypertension in Fetuses with Isolated Congenital Diaphragmatic Hernia in the Fetal Endoscopic Tracleal Occlusion Era: A Single-Center Study.
[congenital diaphragmatic hernia]
Objective
:
To
correlate
prenatal
indicators
of
pulmonary
hypoplasia
with
neonatal
lung
function
and
pulmonary
hypertension
(
PHT
)
in
isolated
congenital
diaphragmatic
hernia
(
iCDH
)
.
Materials
and
Methods
:
Prospective
single
-center
study
on
40
fetuses
with
iCDH
either
expectantly
managed
(
n
=
13
)
or
undergoing
tracheal
occlusion
(
n
=
27
)
.
Prenatal
predictors
included
observed
/
expected
lung
-
head
ratio
(
O
/
E
LHR
)
,
observed
/
expected
total
fetal
lung
volume
,
fetal
pulmonary
reactivity
to
maternal
O
2
administration
(
Δpulsatility
index
,
ΔPI
)
and
liver
-
to
-thorax
ratio
(
LiTR
)
as
measured
in
the
second
and
third
trimesters
.
Postnatal
outcome
measures
included
survival
until
discharge
,
best
oxygenation
index
(
OI
)
and
alveolar
-
arterial
oxygen
gradient
[
D
(
A-
a
)
O
2
]
in
the
first
24
h
of
life
and
the
occurrence
of
PHT
in
the
first
28
days
of
life
.
Results
:
Median
gestational
age
(
GA
)
at
evaluations
was
27
.
2
and
34
.
3
weeks
.
GA
at
delivery
was
36
.
0
weeks
,
and
overall
survival
was
55
%
.
In
the
second
trimester
,
measurement
of
lung
size
,
LiTR
and
pulmonary
reactivity
were
significantly
related
to
survival
and
the
best
OI
and
D
(
A-
a
)
O
2
.
The
occurrence
of
PHT
was
better
predicted
by
ΔPI
and
LiTR
.
Conclusions
:
O
/
E
LHR
,
LiTR
and
vascular
reactivity
correlate
with
ventilatory
parameters
in
the
first
24
h
of
life
.
Occurrence
of
PHT
at
≥
28
days
was
best
predicted
by
LiTR
and
ΔPI
,
but
not
by
lung
size
.
©
2014
S
.
Karger
AG
,
Basel
.
Diseases
Validation
Diseases presenting
"pulmonary reactivity"
symptom
congenital diaphragmatic hernia
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