严重先天性膈疝胎儿气管闭塞后的早产和胎儿肺反应

Prematurity and fetal lung response after tracheal occlusion in fetuses with severe congenital diaphragmatic hernia.

作者信息

Sananes Nicolas, Rodo Carlota, Peiro Jose Luis, Britto Ingrid Schwach Werneck, Sangi-Haghpeykar Haleh, Favre Romain, Joal Arnaud, Gaudineau Adrien, Silva Marcos Marques da, Tannuri Uenis, Zugaib Marcelo, Carreras Elena, Ruano Rodrigo

机构信息

a Department of Obstetrics and Gynecology , Texas Children's Fetal Center, Baylor College of Medicine , Houston , TX , USA .

b Service De Gynécologie Obstétrique, CMCO - HUS, Hôpitaux Universitaires De Strasbourg , Strasbourg , France .

出版信息

J Matern Fetal Neonatal Med. 2016 Sep;29(18):3030-4. doi: 10.3109/14767058.2015.1114080. Epub 2015 Dec 2.

DOI:10.3109/14767058.2015.1114080

PMID:26633729

Abstract

OBJECTIVE

To evaluate the independent association of fetal pulmonary response and prematurity to postnatal outcomes after fetal tracheal occlusion for congenital diaphragmatic hernia.

METHODS

Fetal pulmonary response, prematurity (<37 weeks at delivery) and extreme prematurity (<32 weeks at delivery) were evaluated and compared between survivors and non-survivors at 6 months of life. Multivariable analysis was conducted with generalized linear mixed models for variables significantly associated with survival in univariate analysis.

RESULTS

Eighty-four infants were included, of whom 40 survived (47.6%) and 44 died (52.4%). Univariate analysis demonstrated that survival was associated with greater lung response (p=0.006), and the absence of extreme preterm delivery (p=0.044). In multivariable analysis, greater pulmonary response after FETO was an independent predictor of survival (aOR 1.87, 95% CI 1.08-3.33, p=0.023), whereas the presence of extreme prematurity was not statistically associated with mortality after controlling for fetal pulmonary response (aOR 0.52, 95% CI 0.12-2.30, p=0.367).

CONCLUSION

Fetal pulmonary response after FETO is the most important factor associated with survival, independently from the gestational age at delivery.

摘要

目的

评估胎儿气管闭塞治疗先天性膈疝后，胎儿肺部反应及早产与出生后结局的独立相关性。

方法

对出生后6个月的存活者和非存活者的胎儿肺部反应、早产（分娩时孕周<37周）和极早产（分娩时孕周<32周）进行评估和比较。对单因素分析中与生存显著相关的变量，采用广义线性混合模型进行多变量分析。

结果

纳入84例婴儿，其中40例存活（47.6%），44例死亡（52.4%）。单因素分析表明，生存与更大的肺部反应相关（p=0.006），且与无极早产相关（p=0.044）。多变量分析中，胎儿气管闭塞术后更大的肺部反应是生存的独立预测因素（校正后比值比1.87，95%置信区间1.08-3.33，p=0.023），而在控制胎儿肺部反应后，极早产的存在与死亡率无统计学关联（校正后比值比0.52，95%置信区间0.12-2.30，p=0.367）。