Abstract:
Pulmonary hypoplasia is one of main causes of neonatal mortality and morbidity in patients with congenital diaphragmatic hernia. With most cases diagnosed prenatally, the emphasis is put on prediction of the severity of this defect. Several attempts are made to reduce the mortality and provide optimal prenatal and postnatal care. Appropriate estimation of risk of pulmonary hypoplasia also provides an important inclusion criterion for prenatal intervention. The main tool used for the detection and prediction of pulmonary hypoplasia is ultrasound, with an increasing number of available formulas to estimate the risk of occurrence of this phenomenon and complication associated with it. For most of the formulas used in this measurement method, the main limitations are either gestational-age dependency or limited research. Other imaging methods used to assess the risk of pulmonary hypoplasia involve magnetic resonance imaging and vascular assessment of affected lungs. The limitation in these remains the limited accessibility. Currently, the most widely used indexes are observed-to-expected lungs-to-head ratio and presence of liver herniation. These are the 2 most commonly used measurement methods, as they are the basis for patient qualification for fetoscopic endoluminal tracheal occlusion. This article aims to review the evaluation of pulmonary hypoplasia or hypoplastic lung disease as an important determinant of clinical outcomes in infants with congenital diaphragmatic hernia. In this review, we emphasize the importance of early prenatal diagnosis of congenital diaphragmatic hernia and present a summary of different methods of prenatal risk assessment of lung hypoplasia in congenital diaphragmatic hernia.
摘要:
肺发育不良是先天性膈疝新生儿死亡和发病的主要原因之一。大多数病例是产前诊断的,重点是预测这种缺陷的严重程度。为降低死亡率并提供最佳的产前和产后护理,进行了一些尝试。适当估计肺发育不全的风险也为产前干预提供了重要的纳入标准。用于检测和预测肺发育不全的主要工具是超声,随着越来越多的可用公式来估计这种现象发生的风险和与之相关的并发症。对于此测量方法中使用的大多数公式,主要限制是胎龄依赖性或研究有限.用于评估肺发育不全风险的其他成像方法包括磁共振成像和受影响肺的血管评估。这些限制仍然是有限的可访问性。目前,最广泛使用的指标是观察到的肺头比和肝疝的存在.这是两种最常用的测量方法,因为它们是胎儿镜下腔内气管封堵患者资格的基础。本文旨在对先天性膈疝婴儿肺发育不全或肺发育不良的评估作为临床结局的重要决定因素进行综述。在这次审查中,我们强调了先天性膈疝早期产前诊断的重要性,并总结了先天性膈疝肺发育不全产前风险评估的不同方法。