Tracheal Diameter and Respiratory Outcome in Infants with Congenital Diaphragmatic Hernia Treated by Fetal Endoscopic Tracheal Occlusion

Anna Morandi, Francesco Macchini, Marijke Ophorst, Irene Borzani, Fabrizio Ciralli, Andrea Farolfi, Giuliana Anna Porro, Stefania Franzini, Isabella Fabietti, Nicola Persico, Fabio Mosca, Ernesto Leva

Research output: Contribution to journalArticlepeer-review

Abstract

Aim: To evaluate tracheal diameters and their clinical impact in patients with congenital diaphragmatic hernia (CDH) after fetal endoscopic tracheal occlusion (FETO). Methods: Patients born with CDH between January 2012 and August 2016 were divided into two groups: noFETO and FETO. Tracheal diameters at three levels (T1, carina, and maximum tracheal dilation) on chest X-ray at 1, 3, 6, 12, 24, and 36 months of follow-up, requirements of invasive and noninvasive respiratory support, the incidence of respiratory infections, and results of pulmonary function tests (PFT) were compared. Results: A total of 71 patients with CDH were born in the study period, and there were 34/41 survivors in the no-FETO group (82.9%) and 13/30 in the FETO group (43.3%). The maximum tracheal diameter was significantly greater in the FETO group at all ages. No differences were observed in the diameters at T1 and the carina, in the requirements of invasive and noninvasive respiratory support, and in the incidence respiratory infections. At the PFT (6-12 months), the FETO group presented higher respiratory rates (46.1 ± 6.2 vs. 36.5 ± 10.6, p = 0.02). No differences in PFT results were found between the groups after the 1st year of life. Conclusions: The FETO procedure leads to persistent tracheomegaly. However, the tracheomegaly does not seem to have a significant clinical impact.

Original languageEnglish
Pages (from-to)296-305
JournalFetal Diagnosis and Therapy
Volume46
Issue number5
DOIs
Publication statusPublished - 2019

Keywords

  • Congenital diaphragmatic hernia
  • Fetal endoscopic surgery
  • Fetal endoscopic tracheal occlusion
  • Fetal therapy
  • Tracheomegaly

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Embryology
  • Radiology Nuclear Medicine and imaging
  • Obstetrics and Gynaecology

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