Stomach Position Research Articles

Prenatal Predictors of Survival in Isolated Congenital Diaphragmatic Hernia

OBJECTIVE: To evaluate prenatal fetal imaging findings associated with survival to hospital discharge, persistent pulmonary hypertension (PH), and need for extracorporeal membrane oxygenation (ECMO) in fetuses with isolated congenital diaphragmatic hernia (CDH) that are undergoing prenatal expectant management. DATA SOURCES: A systematic search was conducted in MEDLINE through PubMed, EMBASE, Web of Science, and The Cochrane Central, and ClinicalTrials.gov from 2000 up to July 2023. METHODS OF STUDY SELECTION: Studies that reported on prenatal imaging in fetuses with isolated CDH that were undergoing expectant management were included. Primary outcomes were survival to hospital discharge, persistent PH within 28 days of age, and need for ECMO. The quality of studies was assessed using the Newcastle-Ottawa Scale. Meta-analysis was performed when at least two studies reported on the same prenatal imaging evaluation. Subgroup analyses were performed according to the side (left or right) of CDH. TABULATION, INTEGRATION, AND RESULTS: A total of 161 full-text articles were assessed for eligibility, with 48 studies meeting the inclusion criteria: 45 (N=3,977) assessed survival, eight (N=994) assessed persistent PH, and 12 (N=2,085) assessed need for ECMO. The pooled proportion was 2,833 of 3,977 (71.2%, 95% CI, 69.8–72.6%) for survival, 565 of 2,085 (27.1%, 95% CI, 25.2–29.1%) for need for ECMO, and 531 of 994 (53.4%, 95% CI, 50.3–56.6%) for need for persistent PH. Prenatal imaging findings that were significantly associated with survival included: total fetal lung volume (mean difference [MD] 13.42, 95% CI, 11.22–15.62), observed-to-expected (O-E) total fetal lung volume less than 30% (odds ratio [OR] 0.09, 95% CI, 0.05–0.17), O-E total fetal lung volume (MD 14.73, 95% CI, 11.62–17.84, I 2 46%), liver/intrathoracic ratio (MD −9.59, 95% CI, −15.73 to −3.46), O-E lung/head ratio (MD 14.03, 95% CI, 12.69–15.36), O-E lung/head ratio less than 25% (OR 0.07, 95% CI, 0.04–0.13), mediastinal shift angle (MD −6.17, 95% CI, −7.70 to −4.64), stomach position in mid-chest (OR 0.14, 95% CI, 0.06–0.36), and intrathoracic liver (OR 0.23, 95% CI, 0.15–0.35). In subgroup analyses, findings for left-sided CDH remained significant in all the aforementioned findings. The only prenatal imaging finding that was significantly associated with persistent PH was intrathoracic liver (OR 1.96, 95% CI, 1.14–3.37), but this association was no longer significant in subgroup analyses. Prenatal imaging findings that were significantly associated with need for ECMO included: O-E total fetal lung volume (MD −10.08, 95% CI, −13.54 to −6.62), O-E lung/head ratio (MD −9.88, 95% CI, 14.44 to −5.33, I 2 30%), subgroup analysis to the left-sided CDH remained significant, percentage of predicted lung volume (MD −9.81, 95% CI, −13.56 to −6.06, I 2 34%), and intrathoracic liver (OR 2.70, 95% CI, 1.60–4.57, I 2 0%), but this association was no longer significant in left-sided CDH subgroup analysis. CONCLUSION: Several prenatal imaging findings, including lung measurements, intrathoracic liver, and stomach position, were predictive of neonatal survival. Lung measurement was predictive of need for ECMO, and intrathoracic liver was significantly associated with persistent PH and need for ECMO.

Prenatal Predictors of Survival, Pulmonary Hypertension, and ECMO in Isolated CDH Undergoing Expectant Management, A Systematic Review and Meta-analysis

Background and Hypothesis: Congenital diaphragmatic hernia (CDH) is a severe developmental defect affecting 1-4 per 10,000 births, characterized by left/right-sided defect, or mixed with herniation of abdominal contents into thorax, with resultant lung hypoplasia and persistent pulmonary hypertension (PHTN). The study investigates prenatal predictors of survival to hospital discharge, PHTN and the need for ECMO in fetuses with isolated CDH undergoing prenatal expectant management.
 Project Methods: We performed a systematic literature review on prenatal diagnostic tests in fetuses with isolated CDH undergoing expectant management. Primary outcomes included survival-to-hospital discharge, persistent PHTN within 28 days, and ECMO need. Newcastle Ottawa Scale assessed quality of studies. Meta-analysis performed when two or more studies reported on the same test. Subgroup analysis performed according to CDH side.
 Results: 161 full-text articles between 2000-2022 were assed for eligibility; 48 met inclusion criteria. 45 reported on survival, 12 on ECMO need, 8 on PHTN; quality of studies was moderate. Studies included were retrospective (81%) or prospective (19%) regarding fetuses undergoing expectant management (77%), or mixed tracheal occlusion and expectant management (20%). Most studies included mixed (41%) or left-sided (47%) CDH. Survival predicted by TFLV, o/e-TFLV, o/e-TFLV <30%, LiTR, o/e-LHR, o/e-LHR <25%, percentage herniated liver, MSA, stomach position in mid-chest, and liver up. ECMO need predicted by o/e-TFLV, o/e-LHR, and PPLV. These results were confirmed through subgroup analysis of only left-sided lesions. PHTN was predicted by presence of intrathoracic liver (OR-1.96, 95%CI 1.14,3.37, I2-0%); this was not significant after left-sided subgroup analysis.
 Conclusion and Potential Impact: In fetuses with CDH, FLV and presence/percentage of intrathoracic liver predict survival. FLV measurements predict ECMO need. Presence of intrathoracic liver may predict persistent PHTN; further studies are needed. Accurate prognostication of CDH severity would aid patient triage, resource mobilization, and identification of high-risk CDH infants in need of advanced treatment including ECMO or identification of candidates for fetal intervention procedures.

Konjenital Diyafragma Hernisi Tanılı Fetüslerde Prognostik Marker Olarak Mide Pozisyonu

Aim: To examine the relationship between stomach position and neonatal survival in congenital diaphragmatic hernia (CDH). 
 Materials and Method: A total of 36 pregnant women with a diagnosis of fetal CDH, aged between 18-45 years and 22-39 weeks of gestation, who applied Ankara City Hospital Perinatology clinic between December 2019 and December 2022, were analyzed retrospectively. Pregnancies were classified into two categories based on neonatal survival. Demographic characteristics, clinical features and contralateral lung size/head circumference (LHR) ratio, stomach position, and other prognostic indicators were evaluated among the survivor (n=8) and non-survivor (n=22) groups. 
 Results: The mean maternal age was 29.30 ± 1.02 (range 17-40), and 36% (13/36) of the patients were primigravid. The median gestational week at diagnosis was 25.10 (13.5-37.6). There was no statistically significant difference between the survivor and non-survivor groups in terms of CDH type, liver position, gestational week at diagnosis, and median LHR. Grade 2 stomach position was found to be statistically significantly higher in the survivor group (p=0.01). Operation rate and 1st-5th minute Apgar scores were higher than in the non-survivor group (p=0.02, p=0.01, and p=0.00, respectively). 
 Conclusion: Stomach position grading in CDH is a practical and applicable method associated with neonatal survival, and grade 2 stomach position may be a marker associated with increased survival in fetuses with CDH regardless of LHR. It may be useful in assessing neonatal prognosis and planning perinatal management, such as maternal transfer to a tertiary center where fetal interventions are available.

The grading of stomach position for postnatal outcomes in isolated left-sided congenital diaphragmatic hernia: Asystematic review and meta-analysis.

To evaluate the correlation between stomach position (SP) grading and postnatal outcomes in fetuses with isolated left-sided congenital diaphragmatic hernias (CDHs). A literature search was conducted using the PubMed, Embase, and Cochrane Library databases. The corresponding 95% confidence intervals (CIs) were used to assess the differences in the odds of mortality according to the SP graded as level 0 to level 3. To evaluate the reliability of our results, a sensitivity analysis was also conducted. Nine papers with a total of 542 fetuses with isolated left-sided CDH were included. Congenital diaphragmatic hernia pregnancies complicated by an intrathoracic stomach had higher odds of neonatal mortality when compared with intraabdominal stomach (odds ratio [OR] 2.86; 95% CI 1.38-5.94). Four papers with SP grading from level 0 to level 3 were included in a subgroup analysis. Stomach position at level 1 and level 2 had lower odds of neonatal mortality when separately compared to level 3 (OR 0.12; 95% CI 0.04-0.33) and (OR 0.30; 95% CI 0.16-0.54). Stomach position at level 1 had lower odds of neonatal mortality when compared with level 2+3 (OR 0.25; 95% CI 0.09-0.66). Survival of fetuses with isolated left-sided CDH is correlated with the SP.

Surgical Risk Factors for Delayed Oral Feeding Autonomy in Patients with Left-Sided Congenital Diaphragmatic Hernia.

Congenital diaphragmatic hernia (CDH) is a rare disease associated with major nutritional and digestive morbidities. Oral feeding autonomy remains a major issue for the care and management of these patients. The aim of this study was to specify the perinatal risk factors of delayed oral feeding autonomy in patients treated for CDH. This monocentric cohort study included 138 patients with CDH. Eighty-four patients were analyzed after the exclusion of 54 patients (11 with delayed postnatal diagnosis, 5 with chromosomal anomaly, 9 with genetic syndrom, 13 with right-sided CDH, and 16 who died before discharge and before oral feeding autonomy was acquired). They were divided into two groups: oral feeding autonomy at initial hospital discharge (group 1, n = 51) and nutritional support at discharge (group 2, n = 33). Antenatal, postnatal, and perisurgical data were analyzed from birth until first hospital discharge. To remove biased or redundant factors related to CDH severity, statistical analysis was adjusted according to the need for a patch repair. After analysis and adjustment, delayed oral feeding autonomy was not related to observed/expected lung-to-head ratio (LHR o/e), intrathoracic liver and/or stomach position, or operative duration. After adjustment, prophylactic gastrostomy (OR adjusted: 16.3, IC 95%: 3.6-74.4) and surgical reoperation (OR adjusted: 5.1, IC 95% 1.1-23.7) remained significantly associated with delayed oral feeding autonomy. Delayed oral feeding autonomy occurred in more than one third of patients with CDH. Both prophylactic gastrostomy and surgical reoperation represent significant risk factors. Bowel obstruction might also impact oral feeding autonomy. Prophylactic gastrostomy seems to be a false "good idea" to prevent failure to thrive. This procedure should be indicated case per case. Bowel obstruction and all surgical reoperations represent decisive events that could impact oral feeding autonomy.

Effect of Nasogastric Tube Placement, Manipulation, and Fluid Administration on Transcutaneous Ultrasound Visualization and Assessment of Stomach Position in Healthy Unfed and Fed Horses.

Knowledge of the effects of feeding and nasogastric tube placement and manipulation on gastric ultrasound is limited. Given the variability in duration since feeding and the ubiquitous use of nasogastric tubes in horses with colic, the interpretation of gastric ultrasound in horses with colic requires an understanding of these effects. Cranial to caudal and dorsal to ventral ultrasonographic dimensions of the stomach were obtained in 10 unfed horses and five fed horses, before and after nasogastric tube placement, after checking for reflux and after administration of 6 L of water in unfed horses. Fed horses' stomachs were larger in both cranial to caudal and dorsal to ventral dimension than unfed horses. Nasogastric intubation and the administration of water increased ultrasonographic gastric dimensions in fed and unfed horses. Checking for reflux did not consistently decrease ultrasonographic gastric dimension in fed or unfed horses. Fluid was consistently identified in the stomach with ultrasound after 6 L of water. Increases in gastric ultrasound dimensions found in horses that have been recently fed and/or had a nasogastric tube placed can occur without pathologic gastric distension related to colic and should be interpreted in this context. In contrast, the identification of fluid in the stomach on ultrasound occurs consistently with fluid administration and may be more useful than standard ultrasound parameters of gastric dimensions to identify horses with colic likely to have significant gastric reflux.

Prenatal predictors of mortality in fetuses with congenital diaphragmatic hernia: a systematic review and meta-analysis.

This study aimed to evaluate prenatal predictors of mortality in fetuses with congenital diaphragmatic hernia (CDH). A systematic literature search was performed to identify relevant observational studies that evaluated the ability of lung-to-head ratio (LHR), observed-to-expected LHR (o/e-LHR), observed-to-expected total fetal lung volume (o/e-TFLV), lung-to-thorax transverse area ratio (L/T ratio), intrathoracic herniation of the liver and the stomach, and side of diaphragmatic hernia, using a threshold for the prediction of mortality in fetuses with CDH. Study quality was assessed using the QUADAS-2 tool. Hierarchical summary receiver operating characteristic curves were constructed. A total of 50 articles were included in this meta-analysis. The QUADAS-2 tool identified a high risk of bias in more than one domain scored in all parameters. Among those parameters, the diagnostic odds ratio of mortality with o/e-LHR < 25%, o/e-TFLV < 25%, and L/T ratio < 0.08 were 11.98 [95% confidence interval (CI) 4.65-30.89], 11.14 (95% CI 5.19-23.89), and 10.28 (95% CI 3.38-31.31), respectively. The predictive values for mortality were similar between the presence of liver herniation and retrocardiac fetal stomach position. This systematic review suggests that o/e-LHR, o/e-TFLV, and L/T ratio are equally good predictors of neonatal mortality in fetuses with isolated CDH.

A Study of Variations of the Stomach in Adults and Growth of the Fetal Stomach.

The stomach is a site for various pathological conditions like congestive hypertrophic pyloric stenosis, peptic ulcer, gastroesophageal reflux disease (GERD), and carcinoma of the stomach. Further, for the treatment of obesity too, surgical manipulation of the stomach is done by a bariatric surgeon. With the availability of a wide range of diagnostic tools like barium meals, USG, CT scan, MRI, and endoscopy, it is possible to identify the variations in the position and shape of the stomach and developmental defects while diagnosing diseases. As thorough knowledge of stomach position and variations will help in preoperative planning and preventing inadvertent damage during surgeries, this topic was taken up for research.Aims and objectivesThis study aims to study the variations of the stomach in human cadavers and dead fetuses with regard to its length, shape, capacity, ends, curvatures, and mucosal folding and classify them into various groups. In addition, this study also aims to assess the pattern of growth of the stomach in fetuses.Material and methodsThe stomachs of 50 adult cadavers and 20 dead fetuses were studied by standard dissection method, concerning their topography, shape, level of the cardiac and pyloric orifice, cardiac angle, length of greater (GC) and lesser curvatures (LC), pyloric sphincter, volume, and mucosal folds.ResultsThe stomach was located in the left hypochondriac quadrant in 78% of the samples and in relation to the 7th costal cartilage in 64%. The two main types of classification established were Type I (variation in position along the vertical axis) in 4% and Type II (variation in position along the transverse axis) in 14%. Type III classification comprised the variations in shape, with a J-shaped stomach in 58%, cylindrical in 20%, crescentic in 14%, and reversed L in 8%. The average length showed significant differences in males, 19±2.48 cm vis-a-vis females, 17.1±2.01 cm. In 66% of the cases, the cardiac orifice was to the left of the midline behind the 7th costal cartilage, and the pyloric orifice was to the right, 1.2 cm to the midline and in the transpyloric plane in 76%. The average GC and LC were 33.6±1.43 cm and 27±5.28 cm, respectively. GC was more significant in males. The average length and diameter of the pyloric canal were about 3.56±0.38 cm & 0.77±0.23 cm, respectively. The thickness of the pyloric sphincter did not show a significant gender difference. The average volume was 289.88±69.15 ml. Rugae were normally spaced in 68%, nearly spaced in 18%, and widely spaced in 6%. The fetal stomach measurements were significantly correlated to gestational age and showed linear growth.ConclusionThe study of the morphology of the stomach and its variations are important not only to surgeons and anatomists but also to gastroenterologists. The linear growth of the stomach in embryos helps radiologists and obstetricians to diagnose intrauterine growth retardation (IUGR) and congenital anomalies early.

Prenatal stomach position and volume in relation to postnatal outcomes in left-sided congenital diaphragmatic hernia.

ObjectiveTo examine the association between prenatal stomach position (SP) grade and stomach volume (SV) and the need for pulmonary hypertension (PH) treatment after birth in prenatally diagnosed left‐sided congenital diaphragmatic hernia (CDH), live born >34 weeks.MethodsIn retrospect, SP grade and SV were determined in fetuses with isolated left‐sided CDH from 19 weeks gestational age (GA) onwards at three different time periods (≤24 weeks' GA: US1, 24–30 weeks' GA: US2; ≥30 weeks' GA: US3). Primary outcome was need for treatment of PH after birth. Secondary analyses included the predictive value of SP and SV for other respiratory outcomes and postnatal defect size.ResultsA total of 101 fetuses were included. SP grade was significantly associated with need for treatment of PH (US1, US2, and US3: p < 0.02). Also, prenatal SP grade was positively associated with defect size and development of chronic lung disease (CLD) in survivors. No association was found between SV and respiratory morbidities or postnatal defect size.ConclusionSP grade in left‐sided CDH fetuses is associated with an increased need for PH treatment, a larger postnatal defect size and CLD in survivors. We consider SP determination a valuable contribution to the prenatal assessment of left‐sided CDH.

Efektivitas Metode 5 S terhadap Respon Nyeri pada Bayi Usia 2-6 Bulan saat Imunisasi Pentavalen

Pentavalent immunization is an immunization developed from a combination of vaccines so that there are eight antigens that can be given to children, namely Hepatitis B, BCG, Oral Polio, Diphtheria, Pertussis, Tetanus, Hib and Measles. The act of immunization can cause pain in babies, so that the baby becomes fussy. The aim of this study is to determine the effectiveness of the 5 S Method (Swaddling, Side / Stomach Position, Shushing, Swinging, Sucking) on Pain Response in Infants aged 2-6 Months during Immunization. Pentavalent. The design of this research is experimental research with the design of Post Test Only Control Group Design. The total sample in this study was 36 babies. This research was conducted at Puskesmas Bestari, Medan. Sampling using consecutive sampling. Collecting data using a FLACC scale questionnaire. Data analysis using paired t-test. The results showed that the effect of the 5S method on the pain response of infants aged 2-6 months during pentavalent immunization was shown by the statistical t-test with p = 0.007 and significantly reduced the pain response of infants at 15 seconds, second. 30, 45 seconds, and can reduce the length of crying babies after injection of pentavalent immunization. The results of this study are expected that nurses can use the 5 S method in relieving the pain response and the duration of crying in infants during immunization or when inserting sharp objects into the baby's body.

Optimal timing of delivery for pregnancies with prenatally diagnosed congenital diaphragmatic hernia: a propensity-score analysis using the inverse probability of treatment weighting.

To evaluate the optimal timing of neonates with prenatally diagnosed congenital diaphragmatic hernia (CDH). Data from a retrospective cohort study conducted by the Japanese CDH Study Group between 2011 and 2018 were divided into two groups according to delivery timing: 36-37 and 38-41 weeks of gestation (wg). Death before 90 days as the primary outcome and the duration of hospitalization, oxygen therapy and tube feeding at discharge as the secondary outcomes were analyzed with generalized linear model applying inverse probability of treatment weighting method. We also performed layered analysis according to stomach position. Among 493 neonates with prenatally diagnosed, isolated and left CDH, 237 were born at 38-41wg. The duration of hospitalization was significantly shorter in those born at 38-41wg, especially among those with stomach malposition, and the other outcomes showed no difference. Delivery at 38-41wg could be beneficial for those with high grade stomach position.

Prenatal stomach position predicts gastrointestinal morbidity at 2 years in fetuses with left-sided congenital diaphragmatic hernia.

The long-term morbidity associated with isolated left-sided congenital diaphragmatic hernia (CDH) has been described previously. However, antenatal criteria impacting gastrointestinal morbidity (GIM) are not yet defined. The objective of this study was to evaluate the effect of fetal stomach position on the risk of GIM at 2 years of age in children with left-sided CDH. This was a retrospective, observational multicenter cohort study of data obtained from January 2010 to January 2014, that included patients whose fetus had isolated left-sided CDH, with or without fetal endoscopic tracheal occlusion (FETO). Prenatal maternal, fetal and pediatric data were collected. Fetal stomach position was evaluated a posteriori by two observers, using ultrasound images at the level of the four-chamber view of the heart that had been obtained to calculate the observed-to-expected lung-area-to-head-circumference ratio (O/E-LHR). Fetal stomach position was graded as follows: Grade 1, stomach not visualized; Grade 2, stomach visualized anteriorly, next to the apex of the heart, with no structure in between the stomach and the sternum; Grade 3, stomach visualized alongside the left ventricle of the heart, and abdominal structures anteriorly; or Grade 4, as Grade 3 but with stomach posterior to the level of the atrioventricular heart valves. The primary outcome was GIM at 2 years of age, assessed in a composite manner, including the occurrence of gastroesophageal reflux disease, need for gastrostomy, duration of parenteral and enteral nutrition and persistence of oral aversion. Regression analysis was performed in order to investigate the effect of O/E-LHR, stomach position and FETO on various GIM outcome variables. Forty-seven patients with fetal left-sided CDH were included in the analysis. Thirteen (27.7%) infants did not meet the criterion of exclusive oral feeding at 2 years of age. Fetal stomach position grade was associated significantly and independently with the duration of parenteral nutrition (odds ratio (OR), 19.86; P = 0.031) and persistence of oral aversion at 2 years (OR, 3.40; P = 0.006). On multivariate analysis, O/E-LHR was predictive of the need for prosthetic patch repair, but not for GIM. FETO did not seem to affect the risk of GIM at 2 years. In isolated left-sided CDH, fetal stomach position is the only factor that is predictive of GIM at 2 years of age. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.

Interrater agreement for sonographic stomach position classification in fetal diaphragmatic hernia across the North American Fetal Therapy Network.

To evaluate inter-rater agreement for sonographic classification of stomach position (as a surrogate for liver herniation) in fetal left congenital diaphragmatic hernia (LCDH) among: (i) fetal medicine specialists from the North American Fetal Therapy Network (NAFTNet) centers within and without the fetal endoscopic tracheal occlusion (FETO) consortium and in comparison to an expert external reviewer (ER1); and (iii) among two expert ERs (ER1 and ER2). Forty-eight physicians from 26 NAFTNet centers and 2 ERs were asked to assess 13 sonographic clips of isolated LCDH and classify stomach position as "intra-abdominal," "anterior left chest," "mid to posterior left chest," or "retro-cardiac" based on the classification published by Basta et al.8 Interrater agreement was assessed by determining proportion of stomach position ratings concordant amongst NAFTNet participants and ER1. Agreement for stomach position between ERs was calculated using kappa statistics. Agreement for stomach position was 69% (39%-85%; n=19) and 54% (23%-92%; n=29) among FETO and non-FETO NAFTNet participants, respectively, when compared to ER1. Most disagreement in stomach position was related to a discrepancy of one position. ERs were in agreement for stomach position in 5 of 13 cases (38.5%) and inter-rater agreement was highest for "anterior" stomach position. Interrater agreement for stomach position assessment in CDH was poor across NAFTNet and indeed amongst expert reviewers.

Differential gastric emptiness according to preoperative stomach position in neurological impaired patients who underwent laparoscopic fundoplication and gastrostomy.

We sometimes experienced prolonged delayed gastric emptying (DGE) in neurologically impaired patients undergoing laparoscopic fundoplication and gastrostomy. We explored the difference in the DGE rate according to the preoperative stomach position. Thirty-two neurological impaired patients who underwent laparoscopic fundoplication and gastrostomy between 2015 and 2019 were classified into two groups based on stomach position: non-elevated stomach position (NESP) and elevated stomach position (ESP). Patients' characteristics, operative result and postoperative gastric emptying were reviewed. The 11 ESP patients were significantly older than the 21 NESP patients (p < 0.05). The ESP patients had a significantly heavier body weight (BW) than the NESP patients (p < 0.05). The time taken (days) to reduce gastric drainage (days, below BW × 10ml) in the NESP (4.3 ± 3.6) was significantly longer than that of ESP (1.3 ± 1.6) (p < 0.05). The time taken (days) to achieve full enteral nutrition in the NESP (14.1 ± 8.9) was significantly longer than that of the ESP patients (8.8 ± 3.1) (p < 0.05). Elevated stomach position (ESP) patients archived full enteral nutrition earlier than NESP patients after laparoscopic fundoplication and gastrostomy. Stomach position correction might, therefore, be involved in the incidence of DGE.

Pengaruh Metode 5’S (Swadding, Stomach Position, Sushing, Swingging, Sucking) terhadap Respon Nyeri Bayi Setelah Imunisasi HB-0

Immunization is a source of acute pain in infants that can cause trauma, nonpharmacological techniques that can be done is by giving of 5'S method(swaddling, stomach position, sushing, swinging, and sucking) which are effective and easy to do and the purpose of this study was to find out whether there is an effect of 5'Smethod (swaddling, stomach position, sushing, swinging and sucking) on pain response in infants after Hb-0 immunization at Grandmed Hospital LubukPakam, the method and design of this study was Quasy Experiment with one group pre test and post test design. the population in this study were infants aged0-7 days who received Hb-0 immunization, amounting to 40 people with purposive sampling technique according to inclusion criteria and pain measurement uses the NIPS (Neonatal Infant Pain Scale) pain scale, the data analysis was performed by Paired Sample t-test with a confidence level of 0.05%, the results of the study were lower pain in the treatment group with p = 0.0000 &lt;0.05 (&lt;ɑ), the conclusion of this study is that there was an effect of the 5'S method (swaddling, stomach position, sushing, swinging, and sucking) on pain response in infants after Hb-0 immunization.Immunization is a source of acute pain in infants that can cause trauma, nonpharmacological techniques that can be done is by giving of 5'S method(swaddling, stomach position, sushing, swinging, and sucking) which are effective and easy to do and the purpose of this study was to find out whether there is an effect of 5'Smethod (swaddling, stomach position, sushing, swinging and sucking) on pain response in infants

Анатомічні варіанти вродженої діафрагмальної кили, їх клінічне значення та можливості пренатальної диференціації

Purpose — to present verified typical anatomical variants of isolated congenital diaphragmatic hernia and clinical outcomes in newborns depending on the type of pathology, to compare with data of prenatal examination, and to assess feasibility of prenatal differentiation of congenital diaphragmatic hernia. Materials and methods. The data of operation protocols and autopsy results of newborn patients with isolated congenital diaphragmatic hernia for the period 2007–2020 were analyzed, and then compared with prenatal exam data and clinical outcomes. Data from different anatomical variants of congenital diaphragmatic hernia were analyzed using descriptive statistics methods. Results. Anatomical data were evaluated in 67 cases with the following typical variants: left-sided non-communicating defect (20.9%), left-sided communicating with herniation of intestine (19.4%), intestine and stomach (26,9%), intestine, stomach and liver (19.4%, 13/67), right- sided communicating with intestine and liver herniation (10.4%), right- sided non-communicating (1.5%), bilateral communicating defects (1.5%). Mortality at the stage of stabilization in these variants was 0%, 0%, 11.1%, 30.8%, 71.4%, 0% and 100%, postoperative mortality, respectively, 7.1%, 0%, 12.5%, 44.4%, 0%, 0% (excluding bilateral hernia), total mortality 7.1%, 0%, 22.2%, 61.5%, 71.4%, 0%, 100%. Comparison of lung indices in patients with left-sided hernias showed their similarity in groups with non-communicating defects and communicating with herniation of intestine. Significant differences were found in the groups with herniation of the intestine and stomach, and intestines, stomach and liver. The mean liver-to-lung ratio in right-sided communicating defects was 3.7±1.9, in left-sided communicating defects 1.7±0.8 and in non-communicating 0.44±0.25, the difference between all groups was highly significant. Patterns of stomach position in different variants of pathology were determined. Conclusions. Analysis of postnatally verified cases of diaphragmatic hernia showed marked anatomical variability. The highest mortality and the lowest rate of surgical correction registered was in communicating right-sided defects, and in communicating left-sided with simultaneous herniation of the intestine, stomach and liver. The best outcomes were found in non-communicating defects, or in communicating with herniation of intestine. Prenatal evaluation of stomach position may be the basis to differentiation between clinico-anatomical variants of the pathology. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the Institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: congenital diaphragmatic hernia, congenital malformations, prenatal diagnosis.

Prenatal assessment of congenital diaphragmatic hernia at north american fetal therapy network centers: A continued plea for standardization.

Prenatal work-up for congenital diaphragmatic hernia (CDH) is important for risk stratification, standardization, counseling, and optimal therapeutic choice. To determine current practice patterns regarding prenatal CDH work-up, including prenatal ultrasound and magnetic resonance imaging (MRI) use, and to identify areas for standardization of such evaluation between fetal centers. A survey regarding prenatal CDH work-up was sent to each member center of the North American Fetal Therapy Network (NAFTNet) (n = 36). All responded. Sonographic measurement of lung-to-head ratio (LHR) was determined by all, 89% (32/36) of which routinely calculate observed-to-expected LHR. The method for measuring LHR varied: 58% (21/36) used a "trace" method, 25% (9/36) used "longest axis," and 17% (6/36) used an "antero-posterior" method. Fetal MRI was routinely used in 78% (28/36) of centers, but there was significant variability in fetal lung volume measurement. Whereas all generated a total fetal lung volume, the planes, methodology and references values varied significantly. All evaluated liver position, 71% (20/28) evaluated stomach position and 54% (15/28) quantified the degree of liver herniation. More consistency in workup was seen between centers offering fetal intervention. Prenatal CDH work-up and management differs considerably among North American fetal diagnostic centers, highlighting a need for its standardization.

VP10.20: Prenatal stomach position in second and third trimester in fetuses with congenital diaphragmatic hernia

The aim of the study is to determine the variability of stomach position (SP) between second and third trimester in fetuses with left-sided congenital diaphragmatic hernia (LCDH). Fetuses with isolated LCDH (2007-2018) were evaluated from 19 weeks' gestational age (GA) onwards. Two ultrasound scans were performed: US1 in the second trimester (18-<24 weeks' GA) and US2 in the third trimester (≥30 weeks' GA). Only fetuses with available data on both US1 and US2 were included. SP was assessed on stored 2D ultrasound data and scored 1-4 (grade 1: abdominal; grade 2: anterior in chest; grade 3: mid to posterior in the chest and grade 4: retrocardiac) in accordance to the grading system proposed by Cordier et al. Primary outcome was the agreement of SP grade between the second and third trimester. 43 fetuses with LCDH were eligible for inclusion. Of these 43 fetuses, 8 fetuses (19%) showed a grade 1, 8 (19%) a grade 2, 26 (60%) a grade 3 and 1 (2%) a grade 4 SP at US1. In 38 (88%) fetuses SP grade did not differ between US1 and US2 with a strong agreement between these two measurements (kappa = 0.893, 0.750-0.976). Five fetuses were graded different (12%) at US2 compared to US1. SP grade of one fetus changed from grade 1 at US1 to grade 2 at US2. One fetus who was classified as a grade 2 at US1 appeared to be a grade 1 at US2. Two fetuses had grade 3 at US1 and grade 2 at US2. One fetus had a grade 3 SP at US1 and grade 4 at US2. No fetuses changed more than one grade between the US1 and US2. SP grade in fetuses with LCDH is consistent in the majority of cases throughout the second and third trimester of pregnancy. This knowledge could help us in studying the value of prenatal SP throughout gestation as a predictor of postnatal outcomes in LCDH patients.

VP10.14: Stomach position in correlation to postnatal outcomes in fetuses with congenital diaphragmatic hernia

VP10.14: Stomach position in correlation to postnatal outcomes in fetuses with congenital diaphragmatic hernia

Feasibility and outcomes of fetoscopic endoluminal tracheal occlusion for severe congenital diaphragmatic hernia: A Japanese experience.

AimTo present the feasibility, safety and outcomes of fetoscopic endoluminal tracheal occlusion (FETO) for the treatment of severe congenital diaphragmatic hernia (CDH).MethodsThis was a single‐arm clinical trial of FETO for isolated left‐sided CDH with liver herniation and Kitano Grade 3 stomach position (>50% stomach herniation into the right chest). FETO was performed at 27–29 weeks of gestation for cases with observed/expected lung to head ratio (o/e LHR) <25% and at 30–31 weeks for cases with o/e LHR ≥25%.ResultsEleven cases were enrolled between March 2014 and March 2016, and balloon insertion was successful in all cases. The median o/e LHR at entry was 27% (range, 20–33%). The median gestational age at FETO was 30.9 (range, 27.1–31.7) weeks. There were no severe maternal adverse events. One fetus died unexpectedly at 33 weeks of gestation due to cord strangulation by the detached amniotic membrane. There were 3 cases (27%) of preterm premature rupture of membranes. In all 10 cases, balloon removal at 34–35 weeks of gestation was successful. The median gestational age at delivery was 36.5 (range, 34.2–38.3) weeks. The median duration of occlusion and the median interval between balloon insertion and delivery were 26 days (range: 17–49 days) and 43 days (range, 21–66 days), respectively. Both the survival rate at 90 days of age and the rate of survival to discharge were 45% (5/11).ConclusionThe FETO is feasible without maternal morbidity in Japan and could be offered to women whose fetuses show severe isolated left‐sided CDH to accelerate fetal lung growth.