PDF icon Download PDF
Eur J Pediatr Surg 2024; 34(04): 319-324
DOI: 10.1055/a-2133-8380
Original Article

Maternal and Neonatal Outcomes After Ex-Utero Intrapartum Treatment for Congenital Diaphragmatic Hernia: A Case Series

Angel Chimenea  ‡   *
1   Department of Materno-Fetal Medicine, Genetics, and Reproduction, Institute of Biomedicine of Seville (IBIS), Hospital Universitario Virgen del Rocio/CSIC/University of Seville, Seville, Spain
2   Fetal, IVF, and Reproduction Simulation Training Centre (FIRST), Seville, Spain
,
Marta Domínguez-Moreno  ‡   *
1   Department of Materno-Fetal Medicine, Genetics, and Reproduction, Institute of Biomedicine of Seville (IBIS), Hospital Universitario Virgen del Rocio/CSIC/University of Seville, Seville, Spain
,
María Barrera-Talavera
1   Department of Materno-Fetal Medicine, Genetics, and Reproduction, Institute of Biomedicine of Seville (IBIS), Hospital Universitario Virgen del Rocio/CSIC/University of Seville, Seville, Spain
,
Lutgardo García-Díaz 
1   Department of Materno-Fetal Medicine, Genetics, and Reproduction, Institute of Biomedicine of Seville (IBIS), Hospital Universitario Virgen del Rocio/CSIC/University of Seville, Seville, Spain
3   Department of Surgery, University of Seville, Seville, Spain
,
Guillermo Antiñolo 
1   Department of Materno-Fetal Medicine, Genetics, and Reproduction, Institute of Biomedicine of Seville (IBIS), Hospital Universitario Virgen del Rocio/CSIC/University of Seville, Seville, Spain
2   Fetal, IVF, and Reproduction Simulation Training Centre (FIRST), Seville, Spain
3   Department of Surgery, University of Seville, Seville, Spain
4   Centre for Biomedical Network Research on Rare Diseases (CIBERER), Seville, Spain
› Author Affiliations
Funding None.
› Further Information
Also available ateRef
   Permissions and Reprints
Preview

Abstract

Introduction Despite advances in neonatal intensive care, fetuses with congenital diaphragmatic hernia (CDH) remain to have a poor prognosis. Exclusive postnatal treatment is inadequate in patients with moderate CDH (observed than expected lung-to-head ratio [O/E LHR] 26–45%) and can lead to respiratory failure at birth, requiring extracorporeal membrane oxygenation in 75% of cases. An ex-utero intrapartum treatment (EXIT) procedure may be beneficial in these cases, improving the fetal-neonatal transition.

Material and Methods We review all pregnancies with fetal isolated left CDH with moderate O/E LHR delivered by EXIT in our center from January 2007 to December 2022. Maternal and neonatal variables were analyzed. As primary outcomes, we included neonatal survival and mortality rates, surgical and infectious complications, uterine scar dehiscence, and blood loss during EXIT. As secondary outcomes, we studied recurrences of the diaphragmatic defect, long-term evolution, subsequent pregnancies, and mode of delivery.

Results A total of 14 patients were delivered by the EXIT procedure, with a neonatal survival rate of 85.7%. All these children had optimal physical and neurocognitive development and no pulmonary morbidity. We found no major complications and 7.1% of minor maternal complications. There were no cases of surgical wound infection or endometritis. The median decrease in hemoglobin during the EXIT procedure was 1.9 mg/dL, and only one case required postoperative transfusion. Two out of the 14 women became pregnant again, and both pregnancies were uneventful.

Conclusions In our series, the EXIT procedure allows for adequate airway management associated with a high neonatal survival rate in patients with moderate O/E LHR CDH, with a low rate of neonatal and maternal complications.

Keywords

fetal surgery - congenital diaphragmatic hernia - ex-utero intrapartum treatment - maternal outcomes - neonatal outcomes

Data Availability

The datasets used during the current study are available from the corresponding author on reasonable request.


Authors' Contribution

A.C., M.D., M.B., L.G., and G.A. contributed to the conception and design. M.D. was responsible for the acquisition of data. A.C., M.D., M.B., L.G., and G.A. contributed to the analysis and interpretation of data. All authors contributed to drafting the article or revising it critically for important intellectual content. All authors contributed to the write-up of the manuscript and approved the final version for submission.


* These authors contributed equally to the research and retain the first authorship.




Publication History

Received: 07 May 2023

Accepted: 18 July 2023

Accepted Manuscript online:
20 July 2023

Article published online:
08 September 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany