Usefulness of lung-to-head ratio and intrapulmonary arterial Doppler in predicting neonatal morbidity in fetuses with congenital diaphragmatic hernia treated with fetoscopic tracheal occlusion
Usefulness of lung-to-head ratio and intrapulmonary arterial Doppler in predicting neonatal morbidity in fetuses with congenital diaphragmatic hernia treated with fetoscopic tracheal occlusion
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DOI：
10.1002/uog.11212
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发表时间：
2013-01-01
影响因子：
7.1
通讯作者：
Gratacos, E.
中科院分区：
文献类型：
--
作者：
Cruz-Martinez, R.;Castanon, M.;Gratacos, E.
目的 探讨肺内动脉多普勒测速技术在预测胎儿镜气管闭塞（FETO）治疗的左侧先天性膈疝（CDH）胎儿新生儿发病率中的潜在价值。方法 在 FETO 前 24 小时内，对 51 名妊娠 24 至 33 周患有左侧 CDH 的胎儿组成的连续队列，评估观察到的/预期的肺头比 (O/E-LHR)、肺内多普勒搏动指数和舒张早期反向血流峰值。将肺多普勒参数转换为 Z 分数，如果搏动指数的 Z 分数 > 1.0 或舒张早期反向血流峰值的 Z 分数 > 3.5，则定义为异常。使用根据出生胎龄调整的多元线性或逻辑回归分析来评估 O/E-LHR 和多普勒测速与新生儿结局的关联。结果 26例存活胎儿中，多普勒值正常18例（69.2%），多普勒值异常8例（30.8%）。 O/E-LHR 与存活胎儿的新生儿发病率无关。与多普勒参数正常组相比，肺内多普勒异常病例机械通气时间显着增加（平均增加21.2（95% CI，9.9932.5）天；P < 0.01），常规通气（平均增加15.2（95% CI，7.4323.0）天；P < 0.01），高频通气（平均增加6.34（95% CI，95% CI，P < 0.01）天。 CI，0.6911.99）天；P < 0.05），一氧化氮治疗（5.73（95% CI，0.6010.9）天；P < 0.05），氧支持（36.5（95% CI，16.356.7）天；P < 0.01），肠外营养（19.1（95% CI， 7.5330.7) 天；P < 0.01) 并在新生儿重症监护病房停留 (42.7 (95% CI, 22.962.6) 天；P < 0.001)，高频通气率显着升高 (87.5 vs 44.4%；P < 0.05)，28 日龄时的需氧量 (75.0 vs 11.1%；P < 0.05) 0.01）、胃食管反流（62.5 vs 22.2%；P < 0.05）和出院时管饲（37.5 vs 5.56%；P < 0.05）。结论 正如之前报道的，O/E-LHR 不能预测新生儿发病率。相比之下，肺内动脉多普勒评估可预测接受 FETO 治疗的 CDH 胎儿的新生儿发病率。版权所有 (c) 2012 ISUOG。由约翰·威利父子有限公司出版
Objective To explore the potential value of intrapulmonary artery Doppler velocimetry in predicting neonatal morbidity in fetuses with left-sided congenital diaphragmatic hernia (CDH) treated with fetoscopic tracheal occlusion (FETO). Methods Observed/expected lung-to-head ratio (O/E-LHR), and intrapulmonary Doppler pulsatility index and peak early-diastolic reversed flow were evaluated within 24 h before FETO in a consecutive cohort of 51 fetuses with left-sided CDH at between 24 and 33 weeks' gestation. Lung Doppler parameters were converted into Z-scores and defined as abnormal if the pulsatility index had a Z-score of > 1.0 or the peak early-diastolic reversed flow had a Z-score of > 3.5. The association of O/E-LHR and Doppler velocimetry with neonatal outcome was assessed using multiple linear or logistic regression analysis adjusted for gestational age at birth. Results Among the 26 fetuses that survived, 18 (69.2%) had normal and eight (30.8%) had abnormal Doppler values. O/E-LHR was not associated with neonatal morbidity in surviving fetuses. Compared with the group with normal Doppler parameters, cases with abnormal intrapulmonary Doppler were associated with a significant increase in the duration of mechanical ventilation (average increase of 21.2 (95% CI, 9.9932.5) days; P < 0.01), conventional ventilation (15.2 (95% CI, 7.4323.0) days; P < 0.01), high-frequency ventilation (6.34 (95% CI, 0.6911.99) days; P < 0.05), nitric oxide therapy (5.73 (95% CI, 0.6010.9) days; P < 0.05), oxygen support (36.5 (95% CI, 16.356.7) days; P < 0.01), parenteral nutrition (19.1 (95% CI, 7.5330.7) days; P < 0.01) and stay in neonatal intensive care unit (42.7 (95% CI, 22.962.6) days; P < 0.001), and with significantly higher rates of high-frequency ventilation (87.5 vs 44.4%;P < 0.05), oxygen requirement at 28 days of age (75.0 vs 11.1%; P < 0.01), gastroesophageal reflux (62.5 vs 22.2%; P < 0.05) and tube feeding at discharge (37.5 vs 5.56%; P < 0.05). Conclusion As previously reported, O/E-LHR did not predict neonatal morbidity. In contrast, intrapulmonary artery Doppler evaluation was predictive of neonatal morbidity in CDH fetuses treated with FETO.Copyright (c) 2012 ISUOG. Published by John Wiley & Sons, Ltd.