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Congenital diaphragmatic hernia—influence of fetoscopic tracheal occlusion on outcomes and predictors of survival

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Abstract

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.

Conclusion: 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.

What is Known:

• 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.

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Abbreviations

CDH:

Congenital diaphragmatic hernia

CI:

Confidence interval

CO2 :

Carbon dioxide

ECMO:

Extracorporeal membrane oxygenation

FETO:

Foetal endoscopic tracheal occlusion

HFO:

High frequency oscillation

iNO:

Inhaled nitric oxide

LRH:

Lung-head ratio

OI:

Oxygenation index

PaCO2 :

Arterial carbon dioxide level

RCT:

Randomised controlled trial

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Author’s contribution

KA and AG designed the study; KA, PB, SP and GA collected the data; MO, JP and KA undertook the statistical analysis. All authors were involved in producing the manuscript.

Author information

Authors and Affiliations

  1. Neonatal Intensive Care Unit, King’s College Hospital, 4th Floor Golden Jubilee Wing, Denmark Hill, London, SE5 9RS, UK

    Kamal Ali, Perraju Bendapudi, Satyamaanasa Polubothu, Ann Hickey & Anne Greenough

  2. Division of Asthma, Allergy and Lung Biology, MRC and Asthma UK Centre in Allergic Mechanisms of Asthma, King’s College London, London, UK

    Gwendolyn Andradi & Anne Greenough

  3. Division of Health and Social Care Research, Faculty of Life Sciences and Medicine, King’s College London, London, UK

    Mercy Ofuya & Janet Peacock

  4. NIHR Biomedical Research Centre at Guy’s and St Thomas’ NHS Foundation Trust and King’s College London, London, UK

    Janet Peacock & Anne Greenough

  5. Department of Paediatric Surgery, King’s College Hospital, London, UK

    Mark Davenport

  6. Department of Fetal Medicine, King’s College Hospital, London, UK

    Kypros Nicolaides

Authors
  1. Kamal Ali
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  2. Perraju Bendapudi
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  3. Satyamaanasa Polubothu
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  4. Gwendolyn Andradi
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  5. Mercy Ofuya
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  6. Janet Peacock
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  7. Ann Hickey
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  8. Mark Davenport
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  9. Kypros Nicolaides
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  10. Anne Greenough
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Corresponding author

Correspondence to Anne Greenough.

Ethics declarations

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

This audit was approved by the King’s College Hospital NHS Foundation Trust Clinical Audit Support Committee and, as it was not a research project, it did not require informed parental consent.

Funding

The research was supported by the National Institute for Health Research (NIHR) Biomedical Research Centre based at Guy’s and St Thomas’ NHS Foundation Trust and King’s College London. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Communicated by Patrick Van Reempts

Revisions received: 16 May 2016 23 May 2016

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Ali, K., Bendapudi, P., Polubothu, S. et al. Congenital diaphragmatic hernia—influence of fetoscopic tracheal occlusion on outcomes and predictors of survival. Eur J Pediatr 175, 1071–1076 (2016). https://doi.org/10.1007/s00431-016-2742-6

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  • DOI: https://doi.org/10.1007/s00431-016-2742-6

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