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42. Early vs late resection of asymptomatic congenital lung malformations

Author

Stephanie M. Cruz, Caraciolo J. Fernandes, Darrell L. Cass, Candace C. Style, Sundeep G. Keswani, Oluyinka O. Olutoye, Patricio E. Lau, Timothy C. Lee, and Mariatu A. Verla

Subjects
medicine.medical_specialty, Pleural effusion, Asymptomatic, Time-to-Treatment, Resection, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, Pregnancy, Cystic Adenomatoid Malformation of Lung, Congenital, 030225 pediatrics, Humans, Medicine, Pneumonectomy, Retrospective Studies, Fetal Therapies, Fetus, Lung, business.industry, Age Factors, Infant, General Medicine, Elective resection, medicine.disease, Surgery, Treatment Outcome, medicine.anatomical_structure, Elective Surgical Procedures, 030220 oncology & carcinogenesis, Pediatrics, Perinatology and Child Health, Female, Level iii, medicine.symptom, business, Complication
Abstract

Purpose To examine postsurgical outcomes of a consecutive series of children treated with elective operations for congenital lung malformations (CLM). Methods A retrospective review was performed on a prospectively collected dataset of all fetuses evaluated for a CLM between July 2001 and June 2016. Prenatal findings, operative treatment and postnatal outcomes were collected. Children having elective operations were divided in two groups based on age at time of surgery. Results Of 220 fetuses, 143 had operations and follow-up at our center. Six had open fetal lobectomy, 17 had EXIT-to-resection, 16 infants had urgent resection for symptoms and 110 with asymptomatic lesions had elective resection. Of these 110, the median fetal maximum CVR was 0.8 [range 0.1–2.2], and median age at operation was 4 (1.5–60) months (58% had resection at ≤ 4 months). Overall complication rate, including air-leak and pleural effusion, was 15%. When comparing those having resection at ≤ 4 months to those > 4 months, there were no significant differences in complication rates or length of stay. Operative time was shorter for patients with early resection (154 ± 59 vs 181 ± 89, p = 0.05). No infant having resection at ≤ 4 months was readmitted. Overall, children survived with good recovery. Conclusion Early elective resection of congenital lung malformations prior to 4 months of age is feasible and not associated with increased operative risk. Type of study Restropective study. Level of evidence Level III.

Published
2019
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48. A novel multimodal computational system using near-infrared spectroscopy predicts the need for ECMO initiation in neonates with congenital diaphragmatic hernia

Author

Darrell L. Cass, Sundeep G. Keswani, Craig G. Rusin, Stephen E. Welty, Patricio E. Lau, Christopher J. Rhee, Stephanie M. Cruz, Caraciolo J. Fernandes, Candace C. Style, Timothy C. Lee, Rodrigo Ruano, and Oluyinka O. Olutoye

Subjects
medicine.medical_specialty, 030219 obstetrics & reproductive medicine, Randomization, business.industry, Congenital diaphragmatic hernia, General Medicine, Computational algorithm, medicine.disease, Surgery, 03 medical and health sciences, surgical procedures, operative, 0302 clinical medicine, Cerebral oxygenation, 030225 pediatrics, Internal medicine, Pediatrics, Perinatology and Child Health, Cardiology, medicine, Model development, Cerebral tissue, Clinical decision, business
Abstract

Background/purpose The purpose of this study was to develop a computational algorithm that would predict the need for ECMO in neonates with congenital diaphragmatic hernia (CDH). Methods CDH patients from August 2010 to 2016 were enrolled in a study to continuously measure cerebral tissue oxygen saturation (cStO2) of left and right cerebral hemispheres. NIRS devices utilized were FORE-SIGHT, CASMED and INVOS 5100, Somanetics. Using MATLAB©, a data randomization function was used to deidentify and blindly group patient's data files as follows: 12 for the computational model development phase (6 ECMO and 6 non-ECMO) and the remaining patients for the validation phase. Results Of the 56 CDH patients enrolled, 22 (39%) required ECMO. During development of the algorithm, a difference between right and left hemispheric cerebral oxygenation via NIRS (ΔHCO) was noted in CDH patients that required ECMO. Using ROC analysis, a ΔHCO cutoff >10% was predictive of needing ECMO (AUC: 0.92; sensitivity: 85%; and specificity: 100%). The algorithm predicted need for ECMO within the first 12h of life and at least 6h prior to the clinical decision for ECMO with 88% sensitivity and 100% specificity. Conclusion This computational algorithm of cerebral NIRS predicts the need for ECMO in neonates with CDH. Level of evidence II

Published
2018
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50. Prenatal diagnosis and outcome of fetal gastrointestinal obstruction

Author

Sundeep G. Keswani, Patricio E. Lau, Rodrigo Ruano, Timothy C. Lee, Oluyinka O. Olutoye, Amy R. Mehollin-Ray, Darrell L. Cass, Christopher I. Cassady, and Stephanie M. Cruz

Subjects
Male, medicine.medical_specialty, medicine.medical_treatment, Prenatal diagnosis, Ultrasonography, Prenatal, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, 0302 clinical medicine, Pregnancy, Prenatal Diagnosis, medicine, Humans, Survival rate, Retrospective Studies, Gastrostomy, Fetus, 030219 obstetrics & reproductive medicine, business.industry, Incidence (epidemiology), Ultrasound, Infant, Newborn, General Medicine, Short bowel syndrome, medicine.disease, Magnetic Resonance Imaging, Bowel obstruction, Treatment Outcome, Pediatrics, Perinatology and Child Health, Female, Parenteral Nutrition, Total, Surgery, Radiology, business, Intestinal Obstruction, Follow-Up Studies
Abstract

Introduction The purpose of this study was to evaluate the accuracy of prenatal diagnosis for fetuses with gastrointestinal (GI) obstruction with correlation to postnatal outcomes. Methods Fetuses diagnosed with GI obstruction (excluding esophageal and duodenal) were reviewed for those evaluated between 2006 and 2016. Prenatal diagnosis and imaging studies were compared to postnatal findings. Outcomes evaluated included diagnostic accuracy, rate of other anomalies, neonatal length of stay, incidence of short bowel syndrome, and discharge with TPN or gastrostomy. Results Forty-eight patients were diagnosed prenatally with obstruction. Six patients were excluded owing to incomplete records and follow-up. Twelve fetuses were diagnosed with ultrasound alone, and thirty-four with ultrasound and MRI. A diagnosis of obstruction was accurate in 88.1% (n = 37/42) with a positive predictive value of 91.3%, while US with MRI had an accuracy of 84.4%. Associated anomalies were highest among fetuses with anorectal obstruction (90.1%), compared to large (50%) or small bowel obstruction (28%). Survival rate was lowest for anorectal obstruction (54.5%), compared to large or small bowel obstruction (100% for both). Conclusion Fetal MRI is an accurate modality in the diagnosis of fetal GI obstruction and can complement findings characterized by ultrasound. Fetuses with anorectal obstruction have a higher rate of associated anomalies and the lowest survival. Level of evidence IIb.

Published
2017
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