Abstract
Background
The death rate from human diaphragmatic hernia (CDH) ranges from 50 to 80%, mainly due to the associated lung hypoplasia. To prevent these irreversible pathological and physical defects, the question of intrauterine surgical intervention arises. The histological changes of the lung tissue after inducement of a diaphragmatic hernia were examined. Of special interest was the time elapsing until the development of lung hypoplasia.
Methods
A model of intrauterine inducement of diaphragmatic hernia was established using five fetal lambs to study consecutive pulmonary hypoplasia. Inducement of a diaphragmatic hernia was undertaken between 105 and 108 days’ gestation. Lung tissue was examined histologically on postoperative days 8, 17, 21, 22, and 25 after inducement of the defect.
Results
On postoperative days 8, 17, and 21, no signs of pulmonary hypoplasia were found on histological examination. A pulmonary hypoplasia was found in two fetuses (on the 22nd and 25th postoperative day). The pathological and anatomical examination of a unilateral pulmonary hypoplasia after a short period of time shows that the artificially created diaphragmatic defect is a good model for producing a congenital diaphragmatic hernia.
Discussion
The severity of the pulmonary hypoplasia is related to the duration of lung compression by the herniated organs. The time elapsing until the development of lung hypoplasia is shorter than expected. Tracheal occlusion seems to be an effective strategy for treatment of the defect CDH, but the best technique for achieving occlusion, and particularly the ideal point in time to carry out “Fetendo,” are unknown. Further research into this congenital illness is required in order to treat it.
Similar content being viewed by others
References
Touloukian RJ, Cole D (1975) A state-wide survey of index pediatric surgical conditions. J Pediatr Surg 10:725–732
Ravitch MM, Barton BA (1974) The need for pediatric surgeons as determined by the volume of work and the mode of delivery of surgical care. Surgery 76:754–763
Harrison MR, Bjordal RI, Landmark F et al (1979) Congenital diaphragmatic hernia. The hidden mortality. J Pediatr Surg 13:227–232
Puri P (1994) Congenital diaphragmatic hernia. Curr Probl Surg 31:787–846
Kluth D, Tenbrinck R, von Ekesparre M, Kangah R, Reich P, Brandsma A, Tibboel D, Lambrecht W (1993) The natural history of congenital diaphragmatic hernia and pulmonary hypoplasia in the embryo. J Pediatr Surg 28:456–462
Berchtold R, Hamelmann H, Peiper HJ (1987) Lehrbuch der Chirurgie. Urban und Schwarzenberg, Munich
Dibbins AW, Wiener LS (1974) Mortality from congenital diaphragmatic hernia. J Pediatr Surg 9:653–659
Fitzgerald RJ (1977) Congenital diaphragmatic hernia. A study of mortality factors. Ir J Med Sci 146:280–286
Nielson OH, Jorgensen AF (1978) Congenital diaphragmatic hernia. Factors affecting survival. Z Kinderchir 24:201–208
Sroji MM, Buck B, Downes JJ (1981) Congenital diaphragmatic hernia: deleterious effects of pulmonary interstitial emphysema and tension extrapulmonary air. J Pediatr Surg 16:45–52
Bloss RS, Arando JV, Beardmore HE (1981) Congenital diaphragmatic hernia. Pathophysiologic and pharmacologic support. Surgery 89:518–521
Harrison MR, Langer JC, Adzick NS, Golbus MS, Filly RA, Anderson RL, Rosen MA, Cullen PW, Goldstein RB, de Lorimar AA (1990) Correction of congenital diaphragmatic hernia in utero. V. Initial clinical experience. J Pediatr Surg 25:47–55
Hentschel R, Wiethoff L, Tercanli S, Holzgrewe W, Becker C, Jorch G (1994) Manifestations and prognosis of congenital diaphragmatic hernia. Z Geburtsh Perinatol 198:81–87
Flake AW (1996) Fetal surgery for congenital diaphragmatic hernia. Semin Pediatr Surg 5:266–274
Evrard VA, Flageole H, Deprest JA, Vandenberghe K, Verheaeghe J, Lerut TE (1997) Intrauterine tracheal obstruction, a new treatment for congenital diaphragmatic hernia, decreases amniotic fluid sodium and chloride concentrations in the fetal lamb. Ann Surg 226:753–758
Papadakis K, De Paepe ME, Tackett LD, Piaseki GJ, Luks FI (1998) Temporary tracheal occlusion causes catch-up lung maturation in a fetal model of diaphragmatic hernia. J Pediatr Surg 33:1030–1037
Haller JA, Signer RD, Golladay AE (1976) Pulmonary and ductal hemodynamics in studies of simulated diaphragmatic hernia of fetal and newborn lambs. J Pediatr Surg 11:675–679
Inselmann LS, Mellins RB (1981) Growth and development of the lung. Pediatrics 98:1–13
Lipsett J, Cool JC, Runciman S, Ford A, Kennedy JD, Martin AJ, Parsons DW (2000) Morphometric analysis of preterm fetal pulmonary development in the sheep model of congenital diaphragmatic hernia. Pediatr Dev Pathol 11:17–28
Hedrick MH, Sullivan KM, Bealer JF et al (1994) Plug the lung until it grows (PLUG): a new method to treat congenital diaphragmatic hernia. J Pediatr Surg 29:612–617
Harrison MR, Adzick NS, Flake AW, Vanderwall KJ, Bealer JF, Howell LJ, Farrell JA, Filly RA, Rosen MA, Sola A, Goldberg JD (1996) Correction of congenital diaphragmatic hernia in utero. VIII. Response of the hypoplastic lung to tracheal occlusion. J Pediatr Surg 31:1339–1348
Flageole H, Evrard VA, Piedboeuf B, Laberge JM, Lerute TE, Deprest JA (1998) The plug-unplug sequence: an important step to achieve type II pneumocyte maturation in the fetal lamb model. J Pediatr Surg 33:299–303
Harrison MR, Keller RL, Hawgood SB, Kitterman JA, Sandberg PL, Farmer DL, Lee H, Filly RA, Farrell JA, Albanese CT (2003) A randomized trial of fetal endoscopic tracheal occlusion for severe fetal congenital diaphragmatic hernia. N Engl J Med 349:1916–1924
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Hellmeyer, L., Ballast, A., Tekesin, I. et al. Evaluation of the development of lung hypoplasia in the premature lamb. Arch Gynecol Obstet 271, 231–234 (2005). https://doi.org/10.1007/s00404-004-0658-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00404-004-0658-2