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  • 1
    Online Resource
    Online Resource
    Neurodevelopmental Outcome in High-Risk Congenital Diaphragmatic Hernia Patients: An Appeal for International Standardization
    S. Karger AG ; 2016
    In:  Neonatology Vol. 109, No. 1 ( 2016), p. 14-21
    Details
    In: Neonatology, S. Karger AG, Vol. 109, No. 1 ( 2016), p. 14-21
    Abstract: 〈 b 〉 〈 i 〉 Background: 〈 /i 〉 〈 /b 〉 Since mortality in congenital diaphragmatic hernia (CDH) is decreasing, morbidity such as neurodevelopmental outcome is becoming increasingly important. 〈 b 〉 〈 i 〉 Objectives: 〈 /i 〉 〈 /b 〉 We evaluated neurodevelopmental outcome in high-risk CDH patients treated according to the CDH EURO Consortium standardized treatment protocol. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 This observational, prospective cohort study was conducted in two European centers. Neurodevelopment of 88 patients (Rotterdam n = 49; Rome n = 39) was assessed at 12 and 24 months with the Bayley Scales of Infant Development (BSID)-II-NL (Rotterdam) or BSID-III (Rome). Data of the centers were analyzed separately. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 Cognition was normal in 77.8% of children from Rotterdam and in 94.8% from Rome at 12 months, and in 70.7 and 97.4%, respectively, at 24 months. Motor function was normal in 64.3% from Rotterdam and in 81.6% from Rome at 12 months and in 45.7 and 89.8%, respectively, at 24 months. Longer length of hospital stay (LoS) was associated with worse cognitive outcome and motor function; LoS, low socioeconomic status, and ethnicity were associated with lower cognition. 〈 b 〉 〈 i 〉 Conclusions: 〈 /i 〉 〈 /b 〉 At 2 years, most CDH patients have normal cognition, but are at risk for motor function delay. Due to differences in outcomes between centers, careful interpretation is needed before conclusions can be drawn for other centers. Future multicenter collaboration should not only focus on standardization of postnatal care, but also on international standardization of follow-up to identify risk factors and thereby reduce morbidity.
    Type of Medium: Online Resource
    ISSN: 1661-7800 , 1661-7819
    URL: Article
    DOI: 10.1159/000438978
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2016
    detail.hit.zdb_id: 2403535-X
    SSG: 12
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  • 2
    Online Resource
    Online Resource
    Intrafetal Laser Therapy Is a Feasible Treatment for Different Fetal Conditions: A Systematic Review
    S. Karger AG ; 2022
    In:  Fetal Diagnosis and Therapy Vol. 49, No. 11-12 ( 2022), p. 506-517
    Details
    In: Fetal Diagnosis and Therapy, S. Karger AG, Vol. 49, No. 11-12 ( 2022), p. 506-517
    Abstract: 〈 b 〉 〈 i 〉 Introduction: 〈 /i 〉 〈 /b 〉 Over the past years, intrafetal laser (IFL) therapy has been increasingly used in the management of various prenatal conditions. The aim of our research was to clarify the effectiveness and safety of this technique. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 A systematic review of the literature was carried out using MEDLINE/PubMed over a period of 20 years (2001–2021). 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 A total of forty-one articles were selected in the literature search, including 194 cases of twin reversed arterial perfusion (TRAP) sequence, 56 cases of bronchopulmonary sequestrations (BPSs), 5 cases of placental chorioangiomas (PCA), 11 cases of sacrococcygeal teratoma (SCT), and 103 cases of embryo reduction (ER) managed using IFL. In TRAP sequence, perfusion of the acardiac twin was successfully disrupted in all cases. However, preterm premature rupture of membranes (P-PROMs) occurred in 6 out of 79 pregnancies (7.5%), and preterm birth (PTB) occurred in 36 out of 122 pregnancies (29.5%). In BPS, IFL was successfully performed in all cases with no significant fetal-maternal complications. The rates of P-PROM and PTB were, respectively, 3.2% and 12.5%. All PCA IFL-treated cases resulted in successful pregnancy outcomes; no cases of P-PROM were reported, but the rate of PTB reached a peak of 60% due to complications such as severe fetal growth restriction and fetal Doppler abnormalities. In SCT cases, complete cessation of blood flow was achieved in 4 patients (36.4%); P-PROM occurred in 2 cases (18.2%), whereas the rate of PTB was 87.5%. In ER, no intraoperative or major maternal complications were described in the literature. Rates of miscarriage and PTB differed between initial trichorionic triamniotic and dichorionic triamniotic triplet pregnancies. 〈 b 〉 〈 i 〉 Conclusion: 〈 /i 〉 〈 /b 〉 Our analysis suggests that IFL is a safe and feasible technique for the management of different fetal conditions. However, the overall risk of PTB, and its related morbidity and mortality, ranges from 12.5% in BPS to 87.5% in SCT IFL-treated cases. This information could aid in decision-making during prenatal counseling. However, final perinatal outcome depends on the severity of the disease itself.
    Type of Medium: Online Resource
    ISSN: 1015-3837 , 1421-9964
    URL: Article
    DOI: 10.1159/000528485
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2022
    detail.hit.zdb_id: 1482292-1
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