405: Prediction of neonatal respiratory function in fetuses with isolated congenital diaphragmatic hernia (CDH) in the FETO era

Abstract

in fetuses with isolated congenital diaphragmatic hernia (CDH) in the FETO era Jan Deprest, Elisa Done, Paul Lewi, Tim Van Mieghem, Inga Sandaite, Leonardo Gucciardo, Roland Devlieger, Karel Allegaert, Filip Claus University Hospitals Leuven, Division of Woman and Child, Leuven, Belgium, University Hospitals Leuven, Medical Imaging, Leuven, Belgium, University Hospitals Leuven, Neonatology, Leuven, Belgium OBJECTIVE: To correlate prenatal lung hypoplasia indicators and early postnatal lung function as evaluated by oxygenation index (OI) and alveolar arterial oxygen gradient (A-a DO2) in fetuses with isolated Congenital Diaphragmatic Hernia (iCDH). STUDY DESIGN: Prospective single centre study on 40 fetuses with iCDH either expectantly managed (13) or undergoing tracheal occlusion (TO;27) for severe lung hypoplasia. Prenatal predictors included Observed/Expected Lung-Head Ratio (O/E LHR), fetal pulmonary artery reactivity to maternal O2 administration ( PI), Observed/Expected Total Fetal Lung Volume (O/E TFLV) and Liver-to-Thorax ratio (LiTR), measured in the late second and third trimester. In TO cases this was prior to balloon placement and after its removal. Postnatal outcome measures included the best OI and A-a DO2 value in the first 24h of life. Other postnatal outcome variables were survival at discharge and the occurrence of neonatal pulmonary hypertension that did not respond to iNO (severe PHT). RESULTS: 33/40 (82%) were left CDH. Median GA at first evaluation was 27.2 wks (26-29.6) and 34.3 wks (30.1-37) at the second (median interval between two exams: 7 wks (2.4-10)). GA at delivery was 36.0 (30-39.4) wks. 22 (55%) cases (initial median O/E LHR 24%) survived till discharge, 54% of these had undergone TO. All prenatal predictors assessed at 28 wks are significantly related to the best OI and A-a DO2. At 34 wks, PI and the LiTR are predictive of early postnatal respiratory function. The occurrence of severe PHT was best predicted by PI and LiTR. O/E LHR, PI and LiTR at both time points are predictive of neonatal survival, while O/E TFLV was significantly related to postnatal outcome only at the early time point. (Figure: significant bivariate relations; linear or logistic regression R2 values along the line) CONCLUSION: In CDH fetuses prenatal lung size assessment and vascular reactivity measurement are significantly related to early postnatal respiratory function. PHT is significantly related to fetal O2 reactivity as well as liver herniation, but not to lung size measurements. 406 Fetal growth restriction from placental insufficiency is not associated with an inflammatory markers response in umbilical cord blood Line Leduc, Emeline Maisonneuve, Edgard Delvin, Emile Levy, Emilie Grenier, Annie Ouellet, Lucie Morin, Johanne Dube, Maurice Bouity-Voubou, Jean-Marie Moutquin, Jean-Claude Fouron, Stephanie Klam Universite de Montreal and Research Center, CHU Sainte-Justine, Obstetrics and Gynecology, Montreal, QC, Canada, Universite de Montreal and Research Center, CHU Sainte-Justine, Biochemistry, Montreal, QC, Canada, Universite de Montreal and Research Center, CHU Sainte-Justine, Nutrition, Montreal, QC, Canada, Universite de Sherbrooke, Obstetrics and Gynecology, Sherbrooke, QC, Canada, Universite de Montreal and Research Center, CHU Sainte-Justine, Research Center, Montreal, QC, Canada, Universite de Sherbrooke, Research Center, Sherbrooke, QC, Canada, Universite de Montreal and Research Center, CHU Sainte-Justine, Cardiology, Montreal, QC, Canada, Jewish General Hospital, Obstetrics and Gynecology, Montreal, QC, Canada OBJECTIVE: Intrauterine growth restriction (IUGR) has increased risks of cardiovascular disease (CVD). Prenatal exposure to conditions associated with inflammation may predispose to CVD. Our objective was to document 1) whether inflammatory biomarkers (interleukin-6, tumor necrosis factor, serum amyloid A, soluble intercellular vascular cell adhesion molecule and circulating C-reactive protein) are increased in the umbilical cord from IUGR neonates with abnormal Doppler and 2) to assess whether these vary with the severity of IUGR and vascular disease. STUDY DESIGN: This prospective cohort study, involving 3 tertiary care centers, consists of consecutively recruited pregnant women carrying twins. We chose the twin pregnancy model because both fetuses share the same maternal environment thereby avoiding potential confounding factors when comparing inflammation biomarkers. We analysed only twin pairs with one co-twin with IUGR defined as fetal growth 10th percentile. Blood samples were taken at birth from the umbilical vein. Intra-pair comparisons on the biomarkers were performed in using the Student paired t-test for normal distribution and Wilcoxon test for non-parametric distribution. We also verified whether there was a link between early onset IUGR (in the second trimester), severe IUGR ( 5th percentile) and IUGR in presence of reverse diastolic flow, verified by umbilical Doppler. RESULTS: Of the 68 twin pregnancies, 48 were dichorionic-diamniotic and 20 monochorionic twins. We observed no increase in cord blood levels of inflammation markers in growth restricted neonates when compared to their normal twin. Furthermore there was no increase of inflammation markers when we compared fetuses with severe IUGR, early IUGR or IUGR with abnormal umbilical Doppler and their normal counterpart. CONCLUSION: IUGR is not associated with significant differences in cord blood inflammation biomarkers between normal and IUGR twins.(CIHR grant #158179) www.AJOG.org Doppler Assessment, Fetus, Prematurity Poster Session III