Integrated prenatal diagnosis and postnatal treatment for moderate and severe congenital diaphragmatic hernia / 中华围产医学杂志

ABSTRACT

Objective To share our experiences on integrated services in providing fetal diagnosis and postnatal treatment for congenital diaphragmatic hernia(CDH).Methods A retrospective analysis was conducted on 25 pregnancies diagnosed as CDH by both prenatal ultrasound and MRI in Maternal and Children Hospital of Guangdong Province from January 2012 to January 2014.All of the subjects received integral medical management including prenatal management (prenatal diagnosis and consultation), perinatal management (prenatal care and delivery) and neonatal treatment.Results Among the 25 CDH fetuses, 11 were mild, nine were moderate, and five were severe.One severe case, who was diagnosed at 26 gestational weeks, was aborted on demand of the mother.The other 24 cases continued their pregnancy and all delivered after 35 weeks including 13 cesarean sections (one due to twin pregnancy and 12 due to maternal demand) and 11 vaginal birth.The mean gestational age when CDH was diagnosed was (24.5 ± 3.5) weeks, and the 24 women delivered at an average of (37.5 ± 1.4) gestational weeks.The eleven mild cases accepted mask oxygenation.For those 13 moderate or severe CDH cases, all received dexamethasone to promote fetal lung maturity at 32 gestational weeks, seven were intubated before clamp the cord, and the other six did after.These 13 babies accepted high-frequency oscillation ventilation, with a median duration of 58 hours, and some of them treated with inhaled nitric oxide on requirement with a median duration of 52 hours.Except two cases died before operation, the rest 22 cases underwent neonatal surgery.One moderate case died at 48 hours after surgery due to pulmonary hypertension and respiratory failure.Another one severe case withdrew treatment at two months old.The other 20 infants recovered fully.Conclusions Integrated management including prenatal diagnosis and postnatal treatment, provides an effective and streamlined mode for diagnosis and treatment of CDH.Therefore,it might minimize potential medical risks.