Fetal MRI mediastinal shift angle and respiratory and cardiovascular pharmacological support in newborns with congenital diaphragmatic hernia
Fetal MRI mediastinal shift angle and respiratory and cardiovascular pharmacological support in newborns with congenital diaphragmatic hernia
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DOI：
10.1007/s00431-021-04207-8
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发表时间：
2021-07-23
影响因子：
3.6
通讯作者：
Cavallaro, Giacomo
中科院分区：
文献类型：
--
作者：
Amodeo, Ilaria;Borzani, Irene;Cavallaro, Giacomo
在患有先天性膈疝（CDH）的新生儿中，由疝出的器官引起的纵隔移位对肺发育产生负面影响。胎儿磁共振成像（MRI）纵隔移位角（MSA）的评估显示与胎儿肺总体积（TFLV）呈负相关，与新生儿存活率相关。然而，从未调查过与产后发病率的可能关联。我们推测纵隔移位的程度可能与较高的呼吸和心循环功能障碍有关，需要对幸存者进行强化治疗和延长住院时间。我们回顾性地考虑了一组孤立的左侧CDH，我们计算了MSA和在胎儿MRI上观察到的/预期的（O/E）TFLV。我们收集了关于变力性或血管活性药物支持、肺血管扩张剂治疗、机械通气和住院时间的数据。进行一般线性模型。MSA和O/E TFLV呈负相关（Pearson系数-0.65，p <0.001），死亡患者的MSA值高于存活患者（p = 0.011）。在幸存者中，MSA的增加与较长的药物治疗有关（多巴酚丁胺：p = 0.016;多巴胺：p = 0.049;氢化可的松：p = 0.003;一氧化氮：p = 0.002;西地那非：p = 0.039;米力农：p = 0.039;氧气：P = 0.066）和机械通气（P = 0.005），住院时间有增加趋势（P = 0.089.Conclusion：MSA间接反映了肺发育不良，与新生儿护理强度较高有关。然而，需要进一步的研究来巩固这些结果。
In newborns with congenital diaphragmatic hernia (CDH), the mediastinal shift caused by the herniated organs negatively affects lung development. Assessment of the fetal magnetic resonance imaging (MRI) mediastinal shift angle (MSA) was shown to have an inverse correlation with the total fetal lung volume (TFLV), being associated with neonatal survival. However, a possible association with postnatal morbidity has never been investigated. We hypothesize that the degree of the mediastinal shift could be associated with higher respiratory and cardiocirculatory impairment, requiring intensive treatments and extended hospitalization in survivors. We retrospectively consider a cohort of isolated, left-sided CDH, for whom we calculated the MSA and the observed/expected (O/E) TFLV at fetal MRI. We performed a data collection regarding inotropic or vasoactive support, treatment with pulmonary vasodilators, mechanical ventilation, and length of stay. General linear models were performed. The MSA and O/E TFLV were inversely correlated (Pearson's coefficient - 0.65, p < 0.001), and deceased patients showed higher MSA values then survivors (p = 0.011). Among survivors, an increase in MSA was associated with longer pharmacological treatments (dobutamine: p = 0.016; dopamine: p = 0.049; hydrocortisone: p = 0.003; nitric oxide: p = 0.002; sildenafil: p = 0.039; milrinone: p = 0.039; oxygen: p = 0.066), and mechanical ventilation (p = 0.005), with an increasing trend in the length of hospitalization (p = 0.089).Conclusion: The MSA indirectly reflects lung hypoplasia and is associated with a higher neonatal intensity of cares. However, further studies are needed to consolidate the results.