41.
Fetal endoscopic tracheal occlusion reduces pulmonary hypertension in severe congenital diaphragmatic hernia
Style, C. C.; Olutoye, O. O.; Belfort, M. A. ...
Ultrasound in obstetrics & gynecology,
December 2019, 2019-Dec, 2019-12-00, 20191201, Letnik:
54, Številka:
6
Journal Article
ABSTRACT
Objective
Fetal endoscopic tracheal occlusion (FETO) is associated with increased perinatal survival and reduced need for extracorporeal membrane oxygenation (ECMO) in fetuses with severe ...
congenital diaphragmatic hernia (CDH). This study evaluates the impact of FETO on the resolution of pulmonary hypertension (PH) in fetuses with isolated CDH.
Methods
We reviewed retrospectively the medical records of all fetuses evaluated for CDH between January 2004 and July 2017 at a single institution. Fetuses with additional major structural or chromosomal abnormalities were excluded. CDH cases were classified retrospectively into mild, moderate and severe groups based on prenatal magnetic resonance imaging indices (observed‐to‐expected total fetal lung volume and percentage of intrathoracic liver herniation). Presence of PH was determined based on postnatal echocardiograms. Logistic regression analyses were performed to evaluate the relationship between FETO and resolution of PH by 1 year of age while controlling for side of the CDH, use of ECMO, gestational age at diagnosis, gestational age at delivery, fetal gender, sildenafil use at discharge and CDH severity. Resolution of PH by 1 year of age was compared between a cohort of fetuses with severe CDH that underwent FETO and a cohort that did not have the procedure (non‐FETO). A subanalysis was performed restricting the analysis to isolated left CDH. Parametric and non‐parametric tests were used for comparisons.
Results
Of 257 CDH cases evaluated, 72% (n = 184) had no major structural or chromosomal anomalies of which 58% (n = 107) met the study inclusion criteria. The FETO cohort consisted of 19 CDH cases and the non‐FETO cohort (n = 88) consisted of 31 (35%) mild, 32 (36%) moderate and 25 (28%) severe CDH cases. All infants with severe CDH, regardless of whether they underwent FETO, had evidence of neonatal PH. FETO (OR, 3.57; 95% CI, 1.05–12.10; P = 0.041) and ECMO (OR, 5.01; 95% CI, 2.10–11.96; P < 0.001) were independent predictors of resolution of PH by 1 year of age. A higher proportion of infants with severe CDH that underwent FETO had resolution of PH by 1 year after birth compared with infants with severe CDH in the non‐FETO cohort (69% (11/16) vs 28% (7/25); P = 0.017). Similar results were observed when the analysis was restricted to cases with left‐sided CDH (PH resolution in 69% (11/16) vs 28% (5/18); P = 0.032).
Conclusion
In infants with severe CDH, FETO and ECMO are independently associated with increased resolution of PH by 1 year of age. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
več
Dostopno za:
BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
42.
Prenatal brain imaging for predicting need for postnatal hydrocephalus treatment in fetuses that had neural tube defect repair in utero
Zarutskie, A.; Guimaraes, C.; Yepez, M. ...
Ultrasound in obstetrics & gynecology,
March 2019, 2019-Mar, 2019-03-00, 20190301, Letnik:
53, Številka:
3
Journal Article
ABSTRACT
Objective
To determine if brain imaging in fetuses that underwent prenatal repair of neural tube defect (NTD) can predict the need for postnatal hydrocephalus treatment (HT) in the first ...
year postpartum.
Methods
This was a retrospective study of fetuses diagnosed with open NTD that had in‐utero myelomeningocele repair between April 2014 and April 2016. Independent variables were collected from four chronological sets of fetal images: presurgery ultrasound, presurgery magnetic resonance imaging (MRI), 6‐week postsurgery MRI and predelivery ultrasound. The following independent variables were collected from all image sets unless otherwise noted: gestational age, head circumference, mean ventricular width, ventricular volume (MRI only), hindbrain herniation (HBH) score (MRI only), and level of lesion (LOL), defined as the upper bony spinal defect (presurgery ultrasound only). Based on these measurements, additional variables were defined and calculated including change in degree of HBH, ventricular width growth (mm/week) and ventricular volume growth (mL/week). The need for HT (by either ventriculoperitoneal shunt or endoscopic third ventriculostomy with choroid plexus cauterization) was determined by a pediatric neurosurgeon using clinical and radiographic criteria; a secondary analysis was performed using the MOMS trial criteria for hydrocephalus. The predictive value of each parameter was assessed by receiver–operating characteristics curve and logistic regression analyses.
Results
Fifty affected fetuses were included in the study, of which 32 underwent open hysterotomy and 18 fetoscopic repair. Two neonates from the open hysterotomy group died and were excluded from the analysis. The mean gestational ages for the presurgery ultrasound, presurgery MRI, postsurgery MRI and predelivery ultrasound were 21.8 ± 2.1, 22.0 ± 1.8, 30.4 ± 1.6 and 31.0 ± 4.9 weeks, respectively. A total of 16 subjects required HT. The area under the curve (AUC) of predictive accuracy for HT showed that HBH grading on postsurgery MRI had the strongest predictive value (0.86; P < 0.01), outperforming other predictors such as postsurgery MRI ventricular volume (0.73; P = 0.03), MRI ventricular volume growth (0.79; P = 0.01), change in HBH (0.82; P = 0.01), and mean ventricular width on predelivery ultrasound (0.73; P = 0.01). Other variables, such as LOL, mean ventricular width on presurgery ultrasound, mean ventricular width on presurgery and postsurgery MRI, and ventricular growth assessment by MRI or ultrasound, had AUCs < 0.7. Optimal cut‐offs of the variables with the highest AUC were evaluated to improve prediction. A combination of ventricular volume growth ≥ 2.02 mL/week and/or HBH of 3 on postsurgery MRI were the optimal cut‐offs for the best prediction (odds ratio (OR), 42 (95% CI, 4–431); accuracy, 84%). Logistic regression analyses showed that persistence of severe HBH 6 weeks after surgery by MRI is one of the best predictors for HT (OR, 39 (95% CI, 4–369); accuracy, 84%). There was no significant change in the results when the MOMS trial criteria for hydrocephalus were used as the dependent variable.
Conclusions
Persistence of HBH on MRI 6 weeks after prenatal NTD repair independently predicted the need for postnatal HT better than any ultrasound‐ or other MRI‐derived measurements of ventricular characteristics. These results should aid in prenatal counseling and add support to the hypothesis that HBH is a significant driver of hydrocephalus in myelomeningocele patients. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
RESUMEN
Imágenes cerebrales prenatales para predecir el tratamiento postnatal de la hidrocefalia en fetos con reparación de defectos del tubo neural
Objetivos
Determinar si las imágenes cerebrales en fetos que se sometieron a reparación prenatal de defectos del tubo neural (DTN) pueden predecir la necesidad de tratamiento postnatal de la hidrocefalia (TH) en el primer año después del parto.
Métodos
Este fue un estudio retrospectivo de fetos diagnosticados con DTN aun abierto cuyo mielomeningocele fue reparado en el útero, entre abril de 2014 y abril de 2016. Se recolectaron variables independientes de cuatro conjuntos cronológicos de imágenes fetales: ecografía prequirúrgica, imágenes por resonancia magnética (IRM) prequirúrgica, imágenes por resonancia magnética (IRM) posquirúrgica a las seis semanas y ecografía previa al parto. Las siguientes variables independientes se recolectaron de todos los conjuntos de imágenes, a menos que se indique lo contrario: edad gestacional, perímetro cefálico, ancho ventricular medio, volumen ventricular (IRM solamente), puntaje de hernia del rombencéfalo (HR) (IRM solamente) y nivel de lesión (NDL), definido como el defecto espinal óseo superior (ecografía prequirúrgica solamente). A partir de estas mediciones se definieron y calcularon variables adicionales, como el cambio en el grado de HR, el aumento del ancho ventricular (mm/semana) y el aumento del volumen ventricular (mL/semana). La necesidad de TH (ya sea por derivación ventriculoperitoneal o por ventriculostomía endoscópica del tercer ventrículo y cauterización del plexo coroideo) fue determinada por un neurocirujano pediátrico utilizando criterios clínicos y radiográficos; se realizó un análisis secundario utilizando los criterios del estudio MOMS para la hidrocefalia. El valor predictivo de cada parámetro se evaluó mediante un análisis de la curva de la característica operativa del receptor y de la regresión logística.
Resultados
Se incluyeron en el estudio 50 fetos afectados, de los cuales 32 se sometieron a histerotomía abierta y 18 a reparación fetoscópica. Dos de los recién nacidos del grupo de histerotomía abierta murieron y fueron excluidos del análisis. Las edades gestacionales medias para la ecografía prequirúrgica, la IRM prequirúrgica, la IRM postoperatoria y la ecografía previa al parto fueron 21,8 ±2,1; 22,0 ±1,8; 30,4 ±1,6 y 31,0 ±4,9 semanas, respectivamente. Un total de 16 sujetos requirieron TH. El área bajo la curva (ABC) de precisión predictiva para la TH mostró que la clasificación de la HR en la IRM postoperatoria tuvo el valor predictivo más fuerte (0,86; P<0.01), por encima de otros valores predictivos como el volumen ventricular en la IRM posquirúrgica (0,73; P=0,03), el crecimiento del volumen ventricular en la IRM (0,79; P=0,01), cambios en la HR (0,82; P=0,01), y el ancho ventricular medio en la ecografía previa al parto (0,73; P=0,01). Otras variables, como el NDL, la anchura ventricular media en la ecografía prequirúrgica, la anchura ventricular media en la IRM prequirúrgica y posquirúrgica, y la evaluación del crecimiento ventricular mediante ecografía o IRM, tuvieron AUC <0,7. Para mejorar la predicción se evaluaron los límites óptimos de las variables con las AUC más altas. Los límites óptimos para la mejor predicción (razones de momios RM, 42 IC 95%: 4–431; precisión, 84%) fueron una combinación de crecimiento del volumen ventricular ≥2,02 mL/semana y/o HR de 3 en la IRM postoperatoria. Los análisis de regresión logística mostraron que la persistencia de la HR grave a las 6 semanas después de la cirugía en IRM es uno de los mejores predictores de la TH (RM, 39 (IC 95%: 4–369); precisión, 84%). Los resultados no cambiaron de forma significativa cuando se utilizaron los criterios del estudio MOMS para la hidrocefalia como variable dependiente.
Conclusiones
La persistencia de la HR en la IRM 6 semanas después de la reparación prenatal de DTN predijo independientemente la necesidad de la TH postnatal mejor que cualquier ecografía o que otras mediciones de las características ventriculares a partir de IRM. Estos resultados deberían ayudar en el asesoramiento previo al parto y a apoyar la hipótesis de que la HR es un impulsor significativo de la hidrocefalia en pacientes con mielomeningocele.
摘要
神经管缺损修复胎儿的产前脑成像预测产后脑积水治疗
目的
确定神经管缺损(NTD)胎儿进行产前修复时脑成像能否预测产后第一年脑积水治疗(HT)的必要性。
方法
这是一个针对确诊罹患开放性神经管缺损，并在2014年4月至2016年4月之间接受宫内脊髓脊膜膨出修复的胎儿的回顾性研究。从四组按时间顺序排列的胎儿图像中收集独立变量:术前超声检查、术前磁共振成像(MRI)、6周术后MRI与分娩前超声检查。从全部图像组别中收集下列独立变量，另有注释的除外:胎龄、头围、平均脑室宽度、脑室容积(对MRI而言)、后脑疝脱(HBH)评分(对MRI而言)和病变程度(LOL)，定义为上骨性脊柱缺损(对术前超声检查而言)。根据这些测量值定义和计算了其他一些变量，包括HBH变化程度、脑室宽度增长率(毫米/周)及脑室容积增长率(毫升/周)。一位小儿神经外科医生采用临床和影像学标准确定需要HT(通过脑室腹腔分流术或内镜第三脑室造瘘术及脉络丛烧灼)，采用脑积水MOMS试验标准进行二次分析。通过受试者工作特征曲线和logistic回归分析评估每个参数的预测值。
结果
研究了50个受影响的胎儿，其中32人接受了开放式子宫切开术，18人接受了胎儿镜修复术。接受开放式子宫切开术的一组中有两个新生儿死亡，没有列为分析对象。术前超声检查组、术前MRI组、术后MRI组与分娩前超声检查组的平均胎龄分别为21.8±2.1周、22.0±1.8周、30.4±1.6周和31.0±4.9周。总共16个受试者需要HT。HT预测精度曲线下面积(AUC)表明，术后MRI HBH评分的预测值是最高的(0.86; P<0.01)，超过术后MRI脑室容积(0.73; P=0.03)、MRI脑室容积增长率(0.79; P=0.01)、HBH变化率(0.82; P=0.01)及分娩前超声检查平均脑室宽度(0.73; P=0.01)之类的其他预测值。LOL、术前超声检查平均脑室宽度、术前术后MRI平均脑室宽度、以及MRI或超声检查脑室增长评估之类的其他变量的AUC小于0.7。评估了AUC最高的那几个变量的最佳临界值，以提高预测精度。脑室容积增长率≥2.02毫升/周和/或术后MRI 3个HBH的组合是实现最佳预测的最佳临界值(比值比(OR)，42 (95% CI, 4–431)；准确度，84%)。逻辑回归分析结果表明，MRI检查术后6周持续性重度HBH是HT的最佳预测值之一(OR, 39 (95% CI, 4–369)；精度，84%)。将脑积水MOMS试验标准用作因变量时，结果基本一样。
结论
产前NTD修复后6周MRI检查持续性HBH独立预测出需要进行产后HT，好于任何脑室特征的超声检查或其他MRI检查值。这些数值应该有助于产前咨询，也印证了这样一个假设，即HBH是脊髓脊膜膨出患者脑积水的重要致病因素。
This article's has been translated into Spanish and Chinese. Follow the links from the to view the translations.
več
Dostopno za:
BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
43.
Impact of the volume of the myelomeningocele sac on imaging, prenatal neurosurgery and motor outcomes: a retrospective cohort study
Corroenne, Romain; Mehollin-Ray, Amy R.; Johnson, Rebecca M. ...
Scientific reports,
06/2021, Letnik:
11, Številka:
1
Journal Article
Abstract
To investigate the association of the myelomeningocele (MMC) volume with prenatal and postnatal motor function (MF) in cases who underwent a prenatal repair. Retrospective cohort study ...
(11/2011 to 03/2019) of 63 patients who underwent a prenatal MMC repair (37 fetoscopic, 26 open-hysterotomy). At referral, measurements of the volume of MMC was performed based on ultrasound scans. A large MMC was defined as greater than the optimal volume threshold (ROC analysis) for the prediction of intact MF at referral (2.7 cc). Prenatal or postnatal intact motor function (S1) was defined as the observation of plantar flexion of the ankle based on ultrasound scan or postnatal examination. 23/63 participants presented a large MMC. Large MMC lesions was associated with an increased risk of having clubfeet by 9.5 times (CI%952.1–41.8, p < 0.01), and reduces the chances of having an intact MF at referral by 0.19 times (CI%950.1–0.6, p < 0.01). At birth, a large MMC reduces the chance of having an intact MF by 0.09 times (CI%950.01–0.49, p < 0.01), and increases the risk of having clubfeet by 3.7 times (CI%950.8–18.3, p = 0.11). A lower proportion of intact MF and a higher proportion of clubfeet pre- or postnatally were observed in cases with a large MMC sac who underwent a prenatal repair.
Trial registration:
Clinicaltrials.gov NCT02230072 and NCT03794011 registered on September 3rd, 2014 and January 4th, 2019.
več
Dostopno za:
IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
44.
Solomon versus selective fetoscopic laser photocoagulation for twin‐twin transfusion syndrome: A systematic review and meta‐analysis
Shamshirsaz, Alireza A.; Chmait, Ramen H.; Stirnemann, Julien ...
Prenatal diagnosis,
January 2023, 2023-01-00, 20230101, 2023, Letnik:
43, Številka:
1
Journal Article
This meta‐analysis aims to compare the perinatal outcome of twin‐twin transfusion syndrome (TTTS) pregnancies undergoing selective versus vascular equator (Solomon) fetoscopic laser photocoagulation ...
(FLP). We performed a systematic search in PubMed and Web of Science from inception up to 25 July 2021. Studies comparing the Solomon and selective techniques of FLP for treatment of TTTS pregnancies were eligible. Random‐effects or fixed‐effect models were used to pool standardized mean differences (SMD) and log odds ratio. Seven studies with a total of 1664 TTTS pregnancies (n = 671 undergoing Solomon and n = 993 selective techniques) were included. As compared to the selective FLP, Solomon was associated with a lower risk of recurrent TTTS compared to the selective technique (Log odds ratio OR: −1.167; 95% credible interval CrI: −2.01, −0.33; p = 0.021; I2: 67%). In addition, Solomon was significantly associated with a higher risk of placental abruption than the selective technique (Log OR: 1.44; 95% CrI: 0.45, 2.47; p = 0.012; I2: 0.0%). Furthermore, a trend for the higher risk of preterm premature rupture of membranes was observed among those undergoing Solomon (Log OR: 0.581; 95% CrI: −0.43, 1.49; p = 0.131; I2: 17%). As compared to selective FLP, the Solomon technique for TTTS pregnancies is associated with a significantly lower recurrence of TTTS; however, it significantly increases the risk of placental abruption.
Key points
What's already known about this topic?
There are conflicting findings regarding adverse effects of different fetoscopic laser photocoagulation techniques, especially Solomon.
What does this study add?
The Solomon technique for twin‐twin transfusion syndrome (TTTS) pregnancies is associated with the lower recurrence of TTTS but significantly the increased risk of placental abruption.
več
Dostopno za:
BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
45.
Chorioamniotic membrane separation following fetal myelomeningocele repair: incidence, risk factors and impact on perinatal outcome
Corroenne, R.; Yepez, M.; Barth, J. ...
Ultrasound in obstetrics & gynecology,
November 2020, 2020-11-00, 20201101, Letnik:
56, Številka:
5
Journal Article
ABSTRACT
Objectives
Prenatal myelomeningocele (MMC) repair has been shown to provide significant benefits to the infant, decreasing the postnatal need for ventriculoperitoneal shunt and improving ...
motor outcome. Chorioamniotic membrane separation (CAS) is a potential complication following prenatal MMC repair and may increase the risk of preterm prelabor rupture of membranes (PPROM) and preterm birth. The objectives of this study were: (1) to evaluate the incidence of CAS after prenatal MMC repair; (2) to determine risk factors associated with its occurrence; and (3) to assess its association with adverse perinatal outcomes.
Methods
This was a retrospective cohort study of patients who underwent fetal MMC repair between November 2011 and December 2018. Surgery was performed using either a fetoscopic (laparotomy or exteriorized uterus) approach or an open‐hysterotomy approach. Eligibility criteria were those reported in the Management of Myelomeningocele Study. If CAS was detected on ultrasound (US), its severity was graded as ‘mild’ if amnion detachment involved < 25% of the uterine cavity, ‘moderate’ if it involved 25–50% and ‘severe’ if it involved > 50%. Evolution of CAS was classified as stable, increasing or decreasing based on the difference in severity grading between the time at first diagnosis and the last US scan before delivery. Logistic regression analysis was performed to identify pre‐ or perisurgical factors associated with the development of CAS and to determine the risk of adverse perinatal outcome associated with CAS.
Results
In total, 91 cases were included. Fetoscopic or open‐hysterotomy repair of MMC was performed in 52/91 (57.1%) and 39/91 (42.9%) cases, at a median gestational age (GA) of 25.0 weeks (range, 22.9–26.0 weeks) and 25.0 weeks (range, 21.3–25.9 weeks), respectively. CAS was diagnosed in 31/91 (34.1%) patients, at a median GA of 28.1 weeks (range, 24.4–37.6 weeks). Anterior placenta was identified as a risk factor for the postoperative development of CAS (odds ratio (OR), 3.72 (95% CI, 1.46–9.5); P < 0.01). This risk was dependent on the repair technique. An anterior placenta significantly increased the risk of CAS after fetoscopic repair (OR, 3.94 (95% CI, 1.14–13.6); P = 0.03) but not after open repair (OR, 2.8 (95% CI, 0.6–12.5); P = 0.16). There was no significant difference in the rate of CAS after fetoscopic repair (21/52 (40.4%)) vs open‐hysterotomy repair (10/39 (25.6%)) (P = 0.14), nor were there any differences in GA at diagnosis of CAS, interval between surgery and diagnosis, distribution of CAS severity or progression of CAS between the two groups. CAS increased the risk of PPROM (50% in those with vs 12% in those without CAS) (OR, 7.6 (95% CI, 2.5–21.9); P < 0.01) and preterm delivery (70% vs 38%) (OR, 3.2 (95% CI, 1.3–8.1); P < 0.01). Fetoscopically repaired cases with CAS had a higher rate of PPROM (12/20 (60.0%) vs 2/31 (6.5%); P < 0.01) and preterm delivery (13/20 (65.0%) vs 5/31 (16.1%); P < 0.01) than those that did not develop CAS, while the differences were not significant in cases with open‐hysterotomy repair. Early detection of CAS (before 30 weeks' gestation) was a risk factor for preterm delivery (90% before 30 weeks vs 36% at or after 30 weeks) (OR, 15.7 (95% CI, 2.3–106.3); P < 0.01). There was no association between PPROM or preterm delivery and the severity or progression of CAS.
Conclusions
The presence of an anterior placenta was the only factor that increased the risk for CAS after fetoscopic MMC repair. Detection of CAS after fetoscopic MMC repair significantly increases the risk for PPROM and preterm delivery. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
več
Dostopno za:
BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
46.
Outcome of laser photocoagulation in monochorionic diamniotic twin pregnancy complicated by Type‐II selective fetal growth restriction
Nassr, A. A.; Hessami, K.; Corroenne, R. ...
Ultrasound in obstetrics & gynecology,
September 2023, 2023-09-00, 20230901, Letnik:
62, Številka:
3
Journal Article
ABSTRACT
Objectives
To evaluate the outcome of monochorionic diamniotic (MCDA) twins complicated by Type‐II selective fetal growth restriction (sFGR) who underwent fetoscopic laser photocoagulation ...
and to validate a previously proposed subclassification system for Type‐II sFGR in a large multicenter cohort.
Methods
This retrospective multicenter cohort study included all MCDA twins complicated by Type‐II sFGR who underwent laser photocoagulation of placental anastomoses at four large tertiary fetal‐care centers between 2006 and 2020. Cases were subclassified according to a recently proposed system based on Doppler evaluation of the ductus venosus (DV) and middle cerebral artery (MCA) into Type‐IIA (normal DV flow and MCA peak systolic velocity (PSV) of the growth‐restricted fetus) or Type‐IIB (absent or reversed flow in the DV during atrial contraction and/or MCA‐PSV ≥ 1.5 multiples of the median of the growth‐restricted fetus). Demographic characteristics and pregnancy outcomes were compared between the groups. Data are presented as mean ± SD or n (%) as appropriate. P‐values < 0.05 were considered statistically significant.
Results
A total of 98 patients with MCDA twins met our inclusion criteria, with 56 subclassified as Type IIA and 42 as Type IIB. Demographic characteristics were similar between the groups; however, Type‐IIB cases had a significantly earlier gestational age at diagnosis and at laser surgery, as well as larger intertwin estimated fetal weight discordance, which may be a reflection of disease severity. Postnatal survival of the growth‐restricted fetus to 30 days of age was significantly lower in Type‐IIB compared to Type‐IIA cases (23.8% vs 46.4%; P = 0.034).
Conclusions
In MCDA twins complicated by Type‐II sFGR and treated with laser photocoagulation of placental anastomoses, preoperative Doppler assessment of the DV and MCA helped identify a subset of patients at increased risk of demise of the growth‐restricted fetus following intervention. This study provides valuable information for guiding surgical management and patient counseling. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.
več
Dostopno za:
BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
47.
Dostopno za:
BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
48.
Perinatal risk factors of neurodevelopmental impairment after fetoscopic laser photocoagulation for twin–twin transfusion syndrome: systematic review and meta‐analysis
Hessami, K.; Nassr, A. A.; Sananès, N. ...
Ultrasound in obstetrics & gynecology,
November 2021, 2021-Nov, 2021-11-00, 20211101, Letnik:
58, Številka:
5
Journal Article
ABSTRACT
Objective
Monochorionic twins with twin–twin transfusion syndrome (TTTS) treated with fetoscopic laser photocoagulation (FLP) are at increased risk of neurodevelopmental impairment (NDI). ...
This meta‐analysis aimed to identify the prevalence of and perinatal risk factors for NDI in TTTS survivors treated with FLP.
Methods
We performed a search in PubMed, EMBASE, Scopus and Web of Science, from inception to 13 February 2021, for studies evaluating perinatal risk factors for NDI in children diagnosed prenatally with TTTS managed by FLP. Data on severity of TTTS at the time of diagnosis, defined according to the Quintero staging system, FLP‐related complications and perinatal outcomes were compared between children with a history of TTTS treated with FLP with and those without NDI, which was defined as performance on a cognitive or developmental assessment tool ≥ 2 SD below the mean or a defined motor or sensory disability. A random‐effects model was used to pool the mean differences or odds ratios (OR) with the corresponding 95% CIs. Heterogeneity was assessed using the I2 statistic.
Results
Nine studies with a total of 1499 TTTS survivors were included. The overall incidence of NDI was 14.0% (95% CI, 9.0–18.0%). The occurrence of NDI in TTTS survivors was associated with later gestational age (GA) at FLP (mean difference, 0.94 weeks (95% CI, 0.50–1.38 weeks); P < 0.0001, I2 = 0%), earlier GA at delivery (mean difference, –1.44 weeks (95% CI, –2.28 to –0.61 weeks); P = 0.0007, I2 = 49%) and lower birth weight (mean difference, –343.26 g (95% CI, –470.59 to –215.92 g); P < 0.00001, I2 = 27%). Evaluation of different GA cut‐offs showed that preterm birth before 32 weeks was associated with higher risk for NDI later in childhood (OR, 2.25 (95% CI, 1.02–4.94); P = 0.04, I2 = 35%). No statistically significant difference was found between cases with and those without NDI with respect to Quintero stage of TTTS, recipient or donor status, development of postlaser twin anemia–polycythemia sequence, recurrence of TTTS and incidence of small‐ for‐gestational age or cotwin fetal demise.
Conclusions
TTTS survivors with later GA at the time of FLP, earlier GA at delivery and lower birth weight are at higher risk of developing NDI. No significant association was found between Quintero stage of TTTS and risk of NDI. Our findings may be helpful for parental counseling and highlight the need for future studies to understand better the risk factors for NDI in TTTS survivors. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
več
Dostopno za:
BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
49.
Randomized, sham-controlled trial of dexamethasone intravitreal implant in patients with macular edema due to retinal vein occlusion
Haller, Julia A; Bandello, Francesco; Belfort, Jr, Rubens ...
Ophthalmology (Rochester, Minn.),
06/2010, Letnik:
117, Številka:
6
Journal Article
To evaluate the safety and efficacy of dexamethasone intravitreal implant (DEX implant; OZURDEX, Allergan, Inc., Irvine, CA) compared with sham in eyes with vision loss due to macular edema (ME) ...
associated with branch retinal vein occlusion (BRVO) or central retinal vein occlusion (CRVO).
Two identical, multicenter, masked, randomized, 6-month, sham-controlled clinical trials (each of which included patients with BRVO and patients with CRVO).
A total of 1267 patients with vision loss due to ME associated with BRVO or CRVO.
A single treatment with DEX implant 0.7 mg (n = 427), DEX implant 0.35 mg (n = 414), or sham (n = 426).
The primary outcome measure for the pooled data from the 2 studies was time to achieve a > or =15-letter improvement in best-corrected visual acuity (BCVA). Secondary end points included BCVA, central retinal thickness, and safety.
After a single administration, the time to achieve a > or =15-letter improvement in BCVA was significantly less in both DEX implant groups compared with sham (P<0.001). The percentage of eyes with a > or =15-letter improvement in BCVA was significantly higher in both DEX implant groups compared with sham at days 30 to 90 (P<0.001). The percentage of eyes with a > or =15-letter loss in BCVA was significantly lower in the DEX implant 0.7-mg group compared with sham at all follow-up visits (P< or =0.036). Improvement in mean BCVA was greater in both DEX implant groups compared with sham at all follow-up visits (P< or =0.006). Improvements in BCVA with DEX implant were seen in patients with BRVO and patients with CRVO, although the patterns of response differed. The percentage of DEX implant-treated eyes with intraocular pressure (IOP) of > or =25 mmHg peaked at 16% at day 60 (both doses) and was not different from sham by day 180. There was no significant between-group difference in the occurrence of cataract or cataract surgery.
Dexamethasone intravitreal implant can both reduce the risk of vision loss and improve the speed and incidence of visual improvement in eyes with ME secondary to BRVO or CRVO and may be a useful therapeutic option for eyes with these conditions.
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Naroči gradivo
50.
Longitudinal evaluation of motor function in patients who underwent prenatal or postnatal neural tube defect repair
Corroenne, R.; Yepez, M.; Pyarali, M. ...
Ultrasound in obstetrics & gynecology,
August 2021, 2021-08-00, 20210801, Letnik:
58, Številka:
2
Journal Article
ABSTRACT
Objective
To compare the evolution of motor function from mid‐gestation to 12 months of age between prenatally and postnatally repaired cases of open neural tube defect (ONTD).
Methods
This ...
was a retrospective cohort study of all fetuses that underwent prenatal (fetoscopic or open hysterotomy) or postnatal ONTD repair at a single institution between November 2011 and December 2018. The anatomical level of the lesion was defined as the upper bony spinal defect at initial magnetic resonance imaging assessment. Prenatal motor function of the lower extremities was evaluated by ultrasound according to the metameric level of the neurological lesion, based on the methodology of Carreras et al. Fetal motor function was assessed at referral, at 6 weeks after surgery in prenatally repaired cases or 6 weeks after referral in postnatally repaired cases (6‐week follow‐up) and at the last scan before delivery. In addition, motor function was assessed by a detailed neurological examination at birth and 12 months of age. First sacral (S1) neurological level of the lesion was considered as intact motor function. For statistical comparisons, we attributed numerical scores to each neurological level and motor function was expressed as median (range) neurological level. Motor function (as numerical score) and the proportion of cases with intact motor function and with motor function two or more levels better than expected based on the anatomical level of the lesion were compared between the prenatal‐ and postnatal‐repair groups. Fetal motor function was compared to the anatomical level of the lesion at referral and a better motor function was defined when it was two or more levels better than the anatomical level of the lesion. To assess the evolution of motor function, we compared motor function at referral with that at each follow‐up assessment using paired t‐tests.
Results
We included 127 patients with ONTD, of whom 93 underwent prenatal (51 fetoscopic and 42 open hysterotomy) and 34 postnatal repair. At the time of referral, cases in the prenatal‐ and postnatal‐repair groups presented with a similar anatomical level of lesion (L3 (T9–S1) vs L3 (T7–S1); P = 0.52), similar motor function (S1 (L1–S1) vs S1 (L1–S1); P = 0.52) and a similar proportion of cases with intact motor function (81% vs 79%; P = 0.88) and with motor function two or more levels better than expected based on the anatomical level of the lesion (62% vs 74%; P = 0.24). When compared with prenatally repaired cases, postnatally repaired cases showed worse motor function at birth (S1 (L1–S1) vs L4 (L1–S1); P < 0.01) and at 12 months of age (S1 (L1–S1) vs L4 (L1–S1); P < 0.01). In the prenatal‐repair group, motor function remained stable from the time of referral to 12 months of age (P = 0.26). Furthermore, the proportion of patients with intact motor function at referral (81% (75/93)) was similar to that at the 6‐week follow‐up (74% (64/87)), at the last scan before birth (74% (42/57)), at birth (68% (63/93)) and at 12 months of age (67% (39/58)) in the prenatal‐repair group. In the postnatal‐repair group, worse motor function, starting from the third trimester to 12 months of age, was observed. The proportion of patients with intact motor function at referral (79% (27/34)) was similar to that at 6‐week follow‐up (80% (12/15); P = 0.92), but was lower at the last assessment before birth (25% (2/8); P < 0.01), at birth (24% (8/34); P < 0.01) and at 12 months of age (28% (7/25); P < 0.01). Similar findings were noted when assessing the evolution of the proportion of cases with motor function two or more levels better than expected based on the anatomical level of the lesion in each group.
Conclusions
Infants with ONTD that underwent postnatal repair had worse motor function at birth and at 12 months of age than at mid‐gestation and when compared with infants that underwent prenatal ONTD repair. Prenatal motor function assessment by ultrasound is an adequate tool to identify those infants who should have a good clinical motor function after delivery. Information obtained by fetal motor function assessment can have an important role for patient counseling and case selection for surgery. © 2020 International Society of Ultrasound in Obstetrics and Gynecology
več
Dostopno za:
BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
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