Fetal stabilization for antenatally diagnosed diaphragmatic hernia

Background/Purpose: Infants with congenital diaphragmatic hernia have pulmo nary hypoplasia resulting in persistent pulmonary hypertension of neonates (PPHN), which is the main contributor to both high mortality and morbidity. The pulmonary artery bed in patients with congenital diaphragmatic hernia (CDH) is underdeveloped and is very sensitive to slight stimuli. It is, the refore, vital to avoid any factors that might increase pulmonary vascular r esistance during the perinatal treatment of these patients. Recently, fetal anesthesia for perinatal stabilization in patients with CDH has been repor ted. However, the efficacy of this method remains controversial. The aim of this study is to analyze the benefits of fetal stabilization using fetal a nesthesia in patients with CDH. Methods: The authors have seen 9 cases of antenatally diagnosed CDH and att empted fetal stabilization. The indication for fetal stabilization was a lu ng thoracic ratio of less than 0.2, without any severe associated anomalies . The protocol for fetal stabilization was (1) monitoring the fetal respira tory movement and heart beat by ultrasonography, (2) the administration of morphine (20 to 30 mg) and diazepam (5 mg) to the mother, (3) the confirmat ion of any interruptions in fetal movement followed by a cesarean section, (4) pancuronimum (0.5 mg) was given through the umbilical vessels, (5) intu bation before clamping of the umbilical cord, and (6) high-frequency oscill atory ventilation (HFO) without bagging. Results: The lung-thratic ratio (LTR) was between 0.06 to 0.17 (average, 0. 10 +/- 0.04). Operation was performed in 7 of 9 patients at between 2.5 and 27 hours after birth. The overall survival rate was 66.7% (6 of 9). All of the patients who underwent operation within 5 hours after birth survived. Conclusions: Perinatal stabilization using fetal anesthesia was found to be effective in preventing PPHN and shortening the period of preoperative sta bilization. It also improved the survival rate of patients with severe CDH. Copyright (C) 1999 by W.B. Saunders Company.