Maternal hyperoxygenation test in fetuses undergoing FETO for severe isolated congenital diaphragmatic hernia
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Maternal hyperoxygenation test in fetuses undergoing FETO for severe
isolated congenital diaphragmatic hernia
Elisa Done’ 1, Karel Allegaert2, Paul Lewi1, Jacques Jani1, Leonardo Gucciardo1,
Tim Van Mieghem1, Eduardo Gratacos3, Roland Devlieger1, Dominique Van
Schoubroeck1, Jan Deprest1
...
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Maternal hyperoxygenation test in fetuses undergoing FETO for severe
isolated congenital diaphragmatic hernia
Elisa Done’ 1 , Karel Allegaert 2 , Paul Lewi1 , Jacques Jani1 , Leonardo Gucciardo1 ,
Tim Van Mieghem1 , Eduardo Gratacos 3 , Roland Devlieger1 , Dominique Van
Schoubroeck1 , Jan Deprest1
From the Division of Woman and Child (Departments 1Obstetrics &
Gynaecology and 2Neonatology) of the University Hospitals Leuven, Leuven,
Belgium and the Department of Obstetrics, Hospital Clinic, Barcelona, Spain.
Corresponding author:
Jan Deprest, MD PhD
Division Woman and Child, Dept. Obstetrics and Gynaecology
UZ Leuven
Herestraat 49 , 3000 Leuven
Tel: + 32 16 344215
Fax: + 32 16 34 4205
Email: jan.deprest@uzleuven.be
This article has been accepted for publication in Ultrasound in Obstetrics &
Gynecology and is currently being edited and typeset. Readers should note that this
article has been fully refereed, but has not been through the technical editing, copy-
editing and proof correction process. Wiley-Blackwell and the International
Society of Ultrasound in Obstetrics and Gynecology cannot be held responsible for
errors or consequences arising from the use of information contained in this
article; nor do the views and opinions expressed necessarily reflect those of Wiley-
Blackwell or the International Society of Ultrasound in Obstetrics and Gynecology
1
,Acknowledgments: The European Commission (EC) supports this work in its 6th Framework
and Marie Curie Fellowship Programme (EuroSTEC; LSHC-CT-2006-037409; MEST CT2005
019707); the Flemish government via its Instituut voor Wetenschap en Technologie (IWT-
070715). E.D. J.J., L.G., T.V.M. are recipients of a grant from the EC. J.D. and K.A. are
recipients of a “Fundamental Clinical Researcher” grant of the Fonds Wetenschappelijk
Onderzoek-Vlaanderen (1801207N and 1800209N).
2
,Abstract
Rationale: Pulmonary hypoplasia and hypertension are the main problems in
newborns with isolated congenital diaphragmatic hernia (CDH). The outcome
can be prenatally predicted by the measurement of contralateral lung size.
Prenatal evaluation of lung vasculature has been much less investigated, and
there are no data on the ability to predict pulmonary hypertension.
Objective: To predict neonatal survival and pulmonary hypertension by
measurement of fetal pulmonary artery reactivity to maternal hyperoxygenation
in fetuses with severe CDH treated by fetoscopic endoluminal tracheal occlusion
(FETO).
Methods: 38 fetuses underwent FETO around 28 wks and the balloon was
removed at 34 weeks. We performed a hyperoxygenation test and measured the
lung-to-head ratio before and after each procedure. Outcome measures were
neonatal survival, occurrence of pulmonary hypertension and its response to
inhaled-NO (iNO)
Results : Fetuses who survived had a larger increase in lung size and decrease of
resistance in the first branch of the main pulmonary artery, than those who died.
Both measures were also predictive of pulmonary hypertension unresponsive to
iNO. The hyperoxygenation test and lung-to-head-ratio were both best predictive
for neonatal survival when measured following balloon removal (p<0.002).
Discriminant analysis confirmed that these two parameters are independent
predictors of outcome.
3
, Conclusions: In fetuses undergoing FETO, pulmonary vascular reactivity in
relation to oxygen and lung size are independent predictors of neonatal survival,
and pulmonary hypertension. The hyperoxygenation test merits further study in
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