Survival outcomes in severe left diaphragmatic hernia with and without fetoscopic tracheal occlusion in a country with suboptimal neonatal management.

Survival outcomes in severe left diaphragmatic hernia with and without fetoscopic tracheal occlusion in a country with suboptimal neonatal management. Ultrasound Obstet Gynecol. 2020 Feb 18;: Authors: Cruz-Martínez R, Martínez-Rodríguez M, Gámez-Varela A, Nieto-Castro B, Luna-García J, Juárez-Martínez I, López-Briones H, Guadarrama-Mora R, Torres-Torres J, Coronel-Cruz F, Ibarra-Rios D, Ordorica-Flores R, Nieto-Zermeño J Abstract OBJECTIVE: To evaluate the impact of Fetal Endoscopic Tracheal Occlusion (FETO) in improving survival for fetuses with severe left congenital diaphragmatic hernia (CDH) and temporary cases managed expectantly during pregnancy in a country with suboptimal neonatal management. METHODS: A cohort of consecutive, isolated left-sided CDH fetuses with normal karyotype and severe pulmonary hypoplasia (liver herniation and observed/expected lung area to head ratio below 26%) were selected for FETO at less than 32 weeks of gestation in a single tertiary referenced center in Queretaro, Mexico. Postnatal outcome (survival up to 28 days after birth) between fetuses treated with FETO and temporary cases with similar lung size but managed expectantly during pregnancy was compared. RESULTS: 25 CDH fetuses treated with FETO were individually matched with 25 counterparts managed expectantly during pregnancy. Endotracheal placement of the balloon was successfull...
Source: The Ultrasound Review of Obstetrics and Gynecology - Category: Radiology Authors: Tags: Ultrasound Obstet Gynecol Source Type: research

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Abstract The aim of this study was to investigate the therapeutic effects and underlying mechanism of tetramethylpyrazine (TMP) on lung development using a rat model of congenital diaphragmatic hernia (CDH). Nitrofen was used to induce CDH. Pregnant rats were divided into three groups: control, CDH, and CDH+TMP. In the CDH and CDH+TMP, fetuses only with left diaphragmatic hernias were chosen for analysis. Lung and body weight were recorded and lung histologic evaluations, image analysis, and western blot analysis of YAP, p-YAP and LATS1 were performed after lung processing. A markedly abnormal structure was observ...
Source: International Journal of Clinical and Experimental Pathology - Category: Pathology Authors: Tags: Int J Clin Exp Pathol Source Type: research
AbstractPurposeWe aimed to evaluate the effect of human mesenchymal stem cells (hMSCs) on congenital diaphragmatic hernia (CDH) by intra-amniotic injection in a rat CDH model.MethodsNitrofen (100  mg) was administered to pregnant rats at E9.5. hMSCs (1.0 × 106) or PBS was injected into each amniotic cavity at E18, and fetuses were harvested at E21. The fetal lungs were classified into normal, CDH, and CDH-hMSCs groups. To determine the lung maturity, we assessed the alveolar histological structure by H&E and Weigert staining and the alveolar arteries by Elastica Van Gieson (EVG) staining. TTF-1, a ...
Source: Pediatric Surgery International - Category: Surgery Source Type: research
oup Abstract The pathogenesis of congenital diaphragmatic hernia (CDH) is largely unknown; however, vitamin A seems to play a role in diaphragmatic development. Previous, case-control studies reported that maternal dietary vitamin A intake was inversely associated with the risk of CDH. To our knowledge, however, there is no prospective evidence regarding this association. Our aim was to examine whether maternal intake of vitamin A was associated with CDH occurrence. Baseline data, from the Japan nationwide birth cohort study (2011-2014), on 89,658 mothers (mean age at delivery = 31·2 years) who delivered si...
Source: The British Journal of Nutrition - Category: Nutrition Authors: Tags: Br J Nutr Source Type: research
We present the case of a 27.5 weeks pregnant woman with a fetal ductus venosus agenesis (DVA) as the main guide marker. To our knowledge this is the first case published in literature reporting a DVA as a guide sign to diagnose a complex condition as Pallister-Killian syndrome. We also underscore the key role of new genetic techniques as microarrays to avoid misdiagnosis when only a subtle sonographic sign is present in complex conditions like this. PMID: 31311125 [PubMed - in process]
Source: Medicina (Kaunas) - Category: Universities & Medical Training Authors: Tags: Medicina (Kaunas) Source Type: research
Abstract The mortality and morbidity of patients with congenital diaphragmatic hernia (CDH) is primarily caused by treatment-resistant, persistent pulmonary hypertension. Structural vascular changes, exemplified by extensive muscularization, are already present early in gestation, but the origin of these abnormalities is unknown. Understanding the origin of the vascular defects is important to improve treatment modalities. Here, we show that the distribution of pericytes is different and may thereby potentially initiate the vascular pathology in CDH. Transient inhibition of retinoic acid signaling early during pre...
Source: American Journal of Physiology. Lung Cellular and Molecular Physiology - Category: Cytology Authors: Tags: Am J Physiol Lung Cell Mol Physiol Source Type: research
CONCLUSIONS: Single umbilical artery was strongly associated with gastro intestinal atresia, suggesting common developmental mechanisms. The increased risk of recurrence of single umbilical artery and malformations suggests that genetic and or persisting environmental factors influence the risks. We found that SUA had an equally strong association to trisomy 13 and 18. This article is protected by copyright. All rights reserved. PMID: 31132166 [PubMed - as supplied by publisher]
Source: The Ultrasound Review of Obstetrics and Gynecology - Category: Radiology Authors: Tags: Ultrasound Obstet Gynecol Source Type: research
Conclusions: Pregestational hypertension is associated with an increased risk of giving birth to a baby with CDH, but no association was observed in pregnancies developing preeclampsia and the occurrence of CDH.Fetal Diagn Ther
Source: Fetal Diagnosis and Therapy - Category: Perinatology & Neonatology Source Type: research
Publication date: Available online 22 March 2019Source: MethodsXAuthor(s): M. Mudri, S.A. Smith, C. Vander Tuin, J. Davidson, T.R.H. Regnault, A. BütterAbstractThe surgical model of congenital diaphragmatic hernia (CDH) has been utilized in exploring treatments and innovative therapies, such as tracheal occlusion (TO). The rabbit is an excellent surgical model compared to others due to lower cost, ease of care, short gestational period, and large litter size. This model is also ideal in studying lung hypoplasia of CDH because rabbit lung development is most similar to humans as alveolarization begins prior to birth an...
Source: MethodsX - Category: Science Source Type: research
CONCLUSION: There is preclinical evidence that maternally administered sildenafil prevents the vascular changes that lead to PPH in CDH newborns. The phase I/IIb clinical study together with the p-PBPK model will define the maternal dose needed for a therapeutic effect in the foetus. Foetal safety will be investigated both in the clinical study and in the sheep. The final step will be a multicentre, randomized, placebo-controlled trial. PMID: 30894101 [PubMed - as supplied by publisher]
Source: Current Pharmaceutical Design - Category: Drugs & Pharmacology Authors: Tags: Curr Pharm Des Source Type: research
CONCLUSION: A high degree of suspicion is required to avoid misdiagnosis and management delay. Surgical treatment must be individualized according to gestational age and clinical setting. PMID: 30799220 [PubMed - as supplied by publisher]
Source: Journal of Obstetrics and Gynaecology Canada : JOGC - Category: OBGYN Tags: J Obstet Gynaecol Can Source Type: research
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