Background and aims: In fetuses with prenatally known CDH can be made a prognosis of the expected lung volume by ultrasound and intrauterine MRI. In patients with poor prognosis the, fetoskopisch tracheal balloon occlusion' (TO) may habe a positive influence over the lung volume and can potentially improve the outcome.
We have matched patients with and without TO and compared the survival.
Mathods: 21 patients were included. A relativated fetal lung volume (RFLV) of under 25% in MRI was elected for inclusion of fetal TO. Excluded were bothsided CDH and syndromes.
As matched pair was the patient selected with CDH and the RFLV, which was closest to the value of the TO patient.
Results: 13 patients had a left sided and 9 a right sided CDH. Gestational age was 35 +2weeks(37+0), birth weight 2463g(2712g). The mean RFLV rate in the intervention group was 19.1% (19.9%) in the 29+0 week (29+6). ECMO was not performed in 4children because of protracted asphyxia, not necessary in 11 children and because of preterm delivery not possible by 2 children.
The ECMO rate among the children in the intervention group was 81%(67%), the ECMO duration was 10,8days (10,0days). Survival rate was 57% (52%).
Conclusions: The late TO is certainly feasible without relevant prematurity and procedure associated mortality. The effect of TO on survival in a standard post-natal setting, including the ECMO treatment option is so far not clearly demonstrated. TO should be done ideally in a large-scale randomized controlled studys.
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Loersch, F., Christ, H., Kohl, T. et al. 514 Effectiveness of Fetoskopisch Tracheal Balloon Occlusion in Neonates with Congenital Diaphragmatic Hernia (CDH). Pediatr Res 68, 263 (2010). https://doi.org/10.1203/00006450-201011001-00514