Congenital diaphragmatic hernia: prenatal diagnosis permits immediate intensive care with high survival rate in isolated cases. A population-based study.

Bétrémieux, Pierre; Gaillot, Théophile; de la Pintière, Armelle; Beuchée, Alain; Pasquier, Laurent; Habonimana, Edouard; Le Bouar, Gwénaelle; Branger, Bernard; Milon, Joëlle; Frémond, Benjamin; Wodey, Eric; Odent, Sylvie; Poulain, Patrice; Pladys, Patrick

Bétrémieux, Pierre; Gaillot, Théophile; de la Pintière, Armelle; Beuchée, Alain; Pasquier, Laurent; Habonimana, Edouard; Le Bouar, Gwénaelle; Branger, Bernard; Milon, Joëlle; Frémond, Benjamin; Wodey, Eric; Odent, Sylvie; Poulain, Patrice; Pladys, Patrick.

Afiliación

Bétrémieux P; Centre Pluridisciplinaire de Diagnostic Prénatal (CPDP) and Réseau Est Bretagne d'Etudes en Médecine Périnatale (REBEMP), Rennes, France. pierre.betremieux@chu-rennes.fr

Prenat Diagn ; 24(7): 487-93, 2004 Jul.

Article en En | MEDLINE | ID: mdl-15300735

RESUMEN

OBJECTIVES: To estimate the prognosis of prenatally diagnosed isolated congenital diaphragmatic hernia (PDICDH) treated with 'immediate planned care' (IPC) between 1999 and 2003 in Eastern Brittany. METHODS: The prognosis of PDICDH was compared with the prognosis of the other live-born CDH, either prenatally undiagnosed or not having had IPC. IPC consisted in prenatal lung maturation with corticosteroids, elective caesarean section at 37 weeks, immediate intubation, surfactant, high- frequency ventilation or oscillation, nitric oxide, intravenous prostacyclin, anaesthesia and haemodynamic support. Surgical repair was performed in the NICU 34 h after birth. RESULTS: The incidence of CDH was 0.8 per thousand with a prenatal diagnosis rate of 27/30 (90%), leading to a termination of pregnancy in nine cases. Ten CDH were associated with other malformations. IPC in PDICDH was performed in 12 cases. The survival rate of PDICDH with IPC was 11/12 versus 1/9 in CDH with no IPC or no prenatal diagnosis (p < 0.01). Logistic regression analysis showed that IPC was determinant for survival (p < 0.01). CONCLUSION: Prenatal diagnosis of isolated CDH treated with immediate planned care is associated with a high survival rate. This suggests that prenatal diagnosis associated with specifically adapted postnatal procedure may improve the prognosis of isolated CDH.

Asunto(s)

Enfermedades Fetales/diagnóstico; Hernia Diafragmática/diagnóstico; Hernias Diafragmáticas Congénitas; Diagnóstico Prenatal; Corticoesteroides/farmacología; Corticoesteroides/uso terapéutico; Cesárea; Femenino; Enfermedades Fetales/embriología; Enfermedades Fetales/terapia; Madurez de los Órganos Fetales/efectos de los fármacos; Edad Gestacional; Hernia Diafragmática/embriología; Hernia Diafragmática/terapia; Humanos; Incidencia; Recién Nacido; Cuidado Intensivo Neonatal; Modelos Logísticos; Pulmón/efectos de los fármacos; Pulmón/embriología; Masculino; Embarazo; Estudios Prospectivos; Tasa de Supervivencia; Resultado del Tratamiento

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Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Diagnóstico Prenatal / Enfermedades Fetales / Hernias Diafragmáticas Congénitas / Hernia Diafragmática Tipo de estudio: Diagnostic_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Female / Humans / Male / Newborn / Pregnancy Idioma: En Revista: Prenat Diagn Año: 2004 Tipo del documento: Article País de afiliación: Francia Pais de publicación: Reino Unido

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