先天性膈疝产前产中治疗后的产妇和新生儿结局:病例系列。

IF 1.5 3区 医学 Q2 PEDIATRICS European Journal of Pediatric Surgery Pub Date : 2024-08-01 Epub Date: 2023-07-20 DOI:10.1055/a-2133-8380
Angel Chimenea, Marta Domínguez-Moreno, María Barrera-Talavera, Lutgardo García-Díaz, Guillermo Antiñolo
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引用次数: 0

摘要

导言:尽管新生儿重症监护技术不断进步,但先天性膈疝(CDH)胎儿的预后仍然很差。对于中度 CDH 患者(肺头比[O/E LHR] 26-45%),产后单纯治疗是不够的,可能导致出生时呼吸衰竭,75% 的病例需要体外膜氧合。产前治疗(EXIT)程序可能对这些病例有益,可改善胎儿-新生儿的过渡:我们回顾了本中心自2007年1月至2022年12月期间通过EXIT分娩的所有胎儿孤立左侧CDH伴中度O/E LHR的孕妇。对产妇和新生儿变量进行了分析。作为主要结果,我们纳入了新生儿存活率和死亡率、手术和感染并发症、子宫瘢痕开裂以及 EXIT 期间的失血量。作为次要结果,我们研究了膈肌缺损的复发、长期演变、后续妊娠和分娩方式:结果:共有14名患者通过EXIT手术分娩,新生儿存活率为85.7%。所有这些患儿的身体和神经认知发育良好,没有肺部疾病。我们没有发现重大并发症,产妇轻微并发症的发生率为 7.1%。没有手术伤口感染或子宫内膜炎病例。EXIT手术期间血红蛋白下降的中位数为1.9 mg/dL,只有一例需要术后输血。14 名妇女中有 2 人再次怀孕,两次妊娠都很顺利:结论:在我们的系列研究中,EXIT手术可对中度O/E LHR CDH患者进行充分的气道管理,新生儿存活率高,新生儿和产妇并发症发生率低。
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Maternal and Neonatal Outcomes After Ex-Utero Intrapartum Treatment for Congenital Diaphragmatic Hernia: A Case Series.

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.

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来源期刊
CiteScore
3.90
自引率
5.60%
发文量
66
审稿时长
6-12 weeks
期刊介绍: This broad-based international journal updates you on vital developments in pediatric surgery through original articles, abstracts of the literature, and meeting announcements. You will find state-of-the-art information on: abdominal and thoracic surgery neurosurgery urology gynecology oncology orthopaedics traumatology anesthesiology child pathology embryology morphology Written by surgeons, physicians, anesthesiologists, radiologists, and others involved in the surgical care of neonates, infants, and children, the EJPS is an indispensable resource for all specialists.
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