Liver position in fetal congenital diaphragmatic hernia retains a prognostic value in the era of lung-protective strategy

Yoshihiro Kitano, Satoshi Nakagawa, Tatsuo Kuroda, Toshiro Honna, Yushi Itoh, Tomoo Nakamura, Nobuyuki Morikawa, Naoki Shimizu, Kyoko Kashima, Satoshi Hayashi, Haruhiko Sago

Research output: Contribution to journalArticle

71 Citations (Scopus)

Abstract

Background/Purpose: The aims of this study were to analyze the outcomes of fetuses with congenital diaphragmatic hernia (CDH) treated by a lung-protective strategy using high-frequency oscillatory ventilation (HFOV) in a single center with a perinatology service and extracorporeal membrane oxygenation (ECMO) capability and to define the natural history of CDH in the era of lung-protective ventilation. Methods: A retrospective chart review of 30 neonates with CDH seen between April 2002 and October 2004 was conducted. All fetuses with a prenatal diagnosis were evaluated by fetal magnetic resonance imaging to define the liver position, and those with a significant volume of the liver in the chest were regarded as liver-up. Patients were managed by a lung-protective strategy using pressure-limited (maximum mean airway pressure [MAP], 18 cm H2O) HFOV. The patients were initially placed on HFOV with a fraction of inspired oxygen (Fio2) of 1.0 and a MAP of 12 cm H2O. Hypercapnea and preductal saturation as low as 85% were accepted. Inhaled nitric oxide and ECMO were introduced when the baby could not be oxygenated with a MAP of 18 cm H2O. Results: Twenty-six neonates (22 inborns with prenatal diagnosis and 4 outborns) were treated with this protocol. Four cases were not treated or died in utero because of severe associated anomalies. Thirteen of the 14 liver-down cases survived without ECMO and were discharged home (93% survival). On the contrary, 4 of 12 liver-up cases survived (33% survival). ECMO was required for initial stabilization in 5 cases with 1 survivor. Conclusions: Liver-down CDH babies have a good chance for survival without ECMO by a planned delivery and the lung-protective strategy using HFOV. Liver herniation demonstrated by prenatal magnetic resonance imaging retains a poor prognostic value even with this approach.

Original languageEnglish
Pages (from-to)1827-1832
Number of pages6
JournalJournal of Pediatric Surgery
Volume40
Issue number12
DOIs
Publication statusPublished - 2005 Dec
Externally publishedYes

Fingerprint

Extracorporeal Membrane Oxygenation
High-Frequency Ventilation
Lung
Liver
Pressure
Prenatal Diagnosis
Survival
Fetus
Perinatology
Magnetic Resonance Imaging
Newborn Infant
Congenital Diaphragmatic Hernias
Ventilation
Survivors
Nitric Oxide
Thorax
Oxygen

Keywords

  • Congenital diaphragmatic hernia
  • Fetus
  • Gentle ventilation
  • Lung-protective strategy

ASJC Scopus subject areas

  • Surgery

Cite this

Liver position in fetal congenital diaphragmatic hernia retains a prognostic value in the era of lung-protective strategy. / Kitano, Yoshihiro; Nakagawa, Satoshi; Kuroda, Tatsuo; Honna, Toshiro; Itoh, Yushi; Nakamura, Tomoo; Morikawa, Nobuyuki; Shimizu, Naoki; Kashima, Kyoko; Hayashi, Satoshi; Sago, Haruhiko.

In: Journal of Pediatric Surgery, Vol. 40, No. 12, 12.2005, p. 1827-1832.

Research output: Contribution to journalArticle

Kitano, Y, Nakagawa, S, Kuroda, T, Honna, T, Itoh, Y, Nakamura, T, Morikawa, N, Shimizu, N, Kashima, K, Hayashi, S & Sago, H 2005, 'Liver position in fetal congenital diaphragmatic hernia retains a prognostic value in the era of lung-protective strategy', Journal of Pediatric Surgery, vol. 40, no. 12, pp. 1827-1832. https://doi.org/10.1016/j.jpedsurg.2005.08.020
Kitano, Yoshihiro ; Nakagawa, Satoshi ; Kuroda, Tatsuo ; Honna, Toshiro ; Itoh, Yushi ; Nakamura, Tomoo ; Morikawa, Nobuyuki ; Shimizu, Naoki ; Kashima, Kyoko ; Hayashi, Satoshi ; Sago, Haruhiko. / Liver position in fetal congenital diaphragmatic hernia retains a prognostic value in the era of lung-protective strategy. In: Journal of Pediatric Surgery. 2005 ; Vol. 40, No. 12. pp. 1827-1832.
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title = "Liver position in fetal congenital diaphragmatic hernia retains a prognostic value in the era of lung-protective strategy",
abstract = "Background/Purpose: The aims of this study were to analyze the outcomes of fetuses with congenital diaphragmatic hernia (CDH) treated by a lung-protective strategy using high-frequency oscillatory ventilation (HFOV) in a single center with a perinatology service and extracorporeal membrane oxygenation (ECMO) capability and to define the natural history of CDH in the era of lung-protective ventilation. Methods: A retrospective chart review of 30 neonates with CDH seen between April 2002 and October 2004 was conducted. All fetuses with a prenatal diagnosis were evaluated by fetal magnetic resonance imaging to define the liver position, and those with a significant volume of the liver in the chest were regarded as liver-up. Patients were managed by a lung-protective strategy using pressure-limited (maximum mean airway pressure [MAP], 18 cm H2O) HFOV. The patients were initially placed on HFOV with a fraction of inspired oxygen (Fio2) of 1.0 and a MAP of 12 cm H2O. Hypercapnea and preductal saturation as low as 85{\%} were accepted. Inhaled nitric oxide and ECMO were introduced when the baby could not be oxygenated with a MAP of 18 cm H2O. Results: Twenty-six neonates (22 inborns with prenatal diagnosis and 4 outborns) were treated with this protocol. Four cases were not treated or died in utero because of severe associated anomalies. Thirteen of the 14 liver-down cases survived without ECMO and were discharged home (93{\%} survival). On the contrary, 4 of 12 liver-up cases survived (33{\%} survival). ECMO was required for initial stabilization in 5 cases with 1 survivor. Conclusions: Liver-down CDH babies have a good chance for survival without ECMO by a planned delivery and the lung-protective strategy using HFOV. Liver herniation demonstrated by prenatal magnetic resonance imaging retains a poor prognostic value even with this approach.",
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AU - Kitano, Yoshihiro

AU - Nakagawa, Satoshi

AU - Kuroda, Tatsuo

AU - Honna, Toshiro

AU - Itoh, Yushi

AU - Nakamura, Tomoo

AU - Morikawa, Nobuyuki

AU - Shimizu, Naoki

AU - Kashima, Kyoko

AU - Hayashi, Satoshi

AU - Sago, Haruhiko

PY - 2005/12

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N2 - Background/Purpose: The aims of this study were to analyze the outcomes of fetuses with congenital diaphragmatic hernia (CDH) treated by a lung-protective strategy using high-frequency oscillatory ventilation (HFOV) in a single center with a perinatology service and extracorporeal membrane oxygenation (ECMO) capability and to define the natural history of CDH in the era of lung-protective ventilation. Methods: A retrospective chart review of 30 neonates with CDH seen between April 2002 and October 2004 was conducted. All fetuses with a prenatal diagnosis were evaluated by fetal magnetic resonance imaging to define the liver position, and those with a significant volume of the liver in the chest were regarded as liver-up. Patients were managed by a lung-protective strategy using pressure-limited (maximum mean airway pressure [MAP], 18 cm H2O) HFOV. The patients were initially placed on HFOV with a fraction of inspired oxygen (Fio2) of 1.0 and a MAP of 12 cm H2O. Hypercapnea and preductal saturation as low as 85% were accepted. Inhaled nitric oxide and ECMO were introduced when the baby could not be oxygenated with a MAP of 18 cm H2O. Results: Twenty-six neonates (22 inborns with prenatal diagnosis and 4 outborns) were treated with this protocol. Four cases were not treated or died in utero because of severe associated anomalies. Thirteen of the 14 liver-down cases survived without ECMO and were discharged home (93% survival). On the contrary, 4 of 12 liver-up cases survived (33% survival). ECMO was required for initial stabilization in 5 cases with 1 survivor. Conclusions: Liver-down CDH babies have a good chance for survival without ECMO by a planned delivery and the lung-protective strategy using HFOV. Liver herniation demonstrated by prenatal magnetic resonance imaging retains a poor prognostic value even with this approach.

AB - Background/Purpose: The aims of this study were to analyze the outcomes of fetuses with congenital diaphragmatic hernia (CDH) treated by a lung-protective strategy using high-frequency oscillatory ventilation (HFOV) in a single center with a perinatology service and extracorporeal membrane oxygenation (ECMO) capability and to define the natural history of CDH in the era of lung-protective ventilation. Methods: A retrospective chart review of 30 neonates with CDH seen between April 2002 and October 2004 was conducted. All fetuses with a prenatal diagnosis were evaluated by fetal magnetic resonance imaging to define the liver position, and those with a significant volume of the liver in the chest were regarded as liver-up. Patients were managed by a lung-protective strategy using pressure-limited (maximum mean airway pressure [MAP], 18 cm H2O) HFOV. The patients were initially placed on HFOV with a fraction of inspired oxygen (Fio2) of 1.0 and a MAP of 12 cm H2O. Hypercapnea and preductal saturation as low as 85% were accepted. Inhaled nitric oxide and ECMO were introduced when the baby could not be oxygenated with a MAP of 18 cm H2O. Results: Twenty-six neonates (22 inborns with prenatal diagnosis and 4 outborns) were treated with this protocol. Four cases were not treated or died in utero because of severe associated anomalies. Thirteen of the 14 liver-down cases survived without ECMO and were discharged home (93% survival). On the contrary, 4 of 12 liver-up cases survived (33% survival). ECMO was required for initial stabilization in 5 cases with 1 survivor. Conclusions: Liver-down CDH babies have a good chance for survival without ECMO by a planned delivery and the lung-protective strategy using HFOV. Liver herniation demonstrated by prenatal magnetic resonance imaging retains a poor prognostic value even with this approach.

KW - Congenital diaphragmatic hernia

KW - Fetus

KW - Gentle ventilation

KW - Lung-protective strategy

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