CORRECTION OF CONGENITAL DIAPHRAGMATIC-HERNIA IN UTERO .2. SIMULATED CORRECTION PERMITS FETAL LUNG GROWTH WITH SURVIVAL AT BIRTH

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  • 1 January 1980
    • journal article
    • research article
    • Vol. 88  (2) , 260-268
Abstract
[Human] infants with congenital diaphragmatic hernia (CDH) die because their lungs are hypoplastic. If hypoplasia is a developmental consequence of compression by herniated viscera, decompression before birth may allow pulmonary development and survival at term. A conical silicone rubber balloon progressively inflated (60-150 ml) in the left hemithoraxi of fetal limbs (days 100-145) simulated compression by growing viscera (CDH). Of 6 neonates delivered by cesarean section, 6 died of severe respiratory insufficiency, despite maximal resuscitation. Lungs were hypoplastic. Lung weight and air capacity were significantly reduced (P < 0.01) compared to controls. Pressure-volume curves revealed decreased compliance and Ba gelatin injections revealed decreased cross-sectional area of the pulmonary vascular bed. Deflation of the balloon at day 120 (simulated correction) allowed sufficient lung growth and development to alleviate respiratory insufficiency and to assure survival in 5 of 5 lambs delivered by cesarean section. Simulated correction produced a significant (P < 0.01) increase in lung weight, air capacity, compliance and area of the pulmonary vascular bed. Efficacy of in utero correction was confirmed by 3 twin studies in which simulated CDH in 1 twin was compared to simulated correction in the other. Infants with CDH may be salvaged by in utero correction.