Affordable Access

Publisher Website

Tracheomegaly in infants with severe congenital diaphragmatic hernia treated with Fetal Endoluminal Tracheal Occlusion

Authors
Journal
The Journal of Pediatrics
0022-3476
Publisher
Elsevier
Volume
164
Issue
6
Identifiers
DOI: 10.1016/j.jpeds.2014.02.023
Keywords
  • Tracheal Occlusion
  • Congenital Diaphragmatic Hernia
  • Fetal Surgery
Disciplines
  • Design
  • Medicine

Abstract

Abstract Objective To measure and evaluate the effects of tracheal dimensions on survival and ventilation in a large series of infants with congenital diaphragmatic hernia (DCH) antenatally treated with fetal endulominal occlusion (FETO). Study design Tracheal dimensions on chest X-rays were measured by two blinded radiologists. Survival, day1 best oxygenation index (d1-BOI), duration of ventilation, CPAP and hospital stay were recorded. Survivors with minimum 12-month-follow-up were longitudinally compared for incidence of gastro-oesophageal reflux, chest infections, chest deformities and hernia recurrence. Results 70 infants with CDH (FETO, n=41) were treated between 2004 and 2010. Hernia repair was performed in 26 infants without FETO (patch repair=8) and 35 infants with FETO (patch repair=26; P=0.0015). Infants with FETO had wider trachea than those without FETO at T1 (P<0.0001) and between T1 and carina (P<0.0001). Tracheal diameter was similar in survivors and non-survivors within the FETO group. Tracheal size did not correlate with d1-BOI in infants with FETO (r2=0.17) and those without FETO (r2=0.07). There were no differences in days of mechanical ventilation (P=0.3), CPAP (P=0.2) and hospital stay (P=0.3). In the longitudinal study, tracheal widths were larger on last CXR than on preoperative ones in patients without FETO (T1, P=0.02; widest point, P=0.001; carina, P=0.0001), and for patients with FETO at widest point (P<0.0001) and at carina (P<0.0001), but not at T1 (P=0.12). The two groups showed no difference in the clinical variables. Conclusion FETO has a significant impact on tracheal size of infants with CDH. However, tracheal size does not impact survival or the requirement for early respiratory support.

There are no comments yet on this publication. Be the first to share your thoughts.