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Respiratory function in infancy following pleuro-amniotic shunting
P J Thompson1, A Greenough, K H Nicolaides
1Department of Child Health, King's College Hospital, London, UK.
Insights
Pleuro-amniotic shunting effectively drained fetal pleural effusions, preventing lung growth impairment. Post-procedure respiratory outcomes in infants were comparable to controls, indicating safety and efficacy.
Area of Science:
- Perinatology
- Pediatric Pulmonology
- Fetal Surgery
Background:
- Fetal pleural effusions can lead to chronic antenatal intrathoracic compression.
- Such compression may impair fetal lung development and impact postnatal respiratory function.
- Pleuro-amniotic shunting is a potential intervention to manage these effusions.
Purpose of the Study:
- To evaluate the effectiveness of pleuro-amniotic shunting in draining fetal pleural effusions.
- To assess the long-term respiratory status of infants following fetal pleural effusion drainage.
- To determine if pleuro-amniotic shunting prevents impaired antenatal lung growth.
Main Methods:
- Retrospective review of 17 infants undergoing pleuro-amniotic shunting for fetal pleural effusions.
- Shunt insertion occurred at a median of 29 weeks gestation.
- Respiratory status assessed via symptom documentation and functional residual capacity (FRC) measurement at a median of 12 months post-procedure.
Main Results:
- Effective chronic drainage of pleural effusions was achieved in all 17 cases.
- 37% of infants experienced recurrent respiratory symptoms, a rate not significantly different from controls.
- Mean FRC was within the normal range for 15 out of 17 infants.
Conclusions:
- Pleuro-amniotic shunting is an effective method for draining fetal pleural effusions.
- The procedure appears to prevent chronic antenatal intrathoracic compression without causing significant long-term respiratory impairment.
- This intervention may help avoid impaired antenatal lung growth.
Abstract:
Respiratory status was assessed at a median of 12 (range 3-60) months in 17 infants who had undergone pleuro-amniotic shunting to drain fetal pleural effusions. The shunts had been inserted at a median of 29 weeks (range 21-35) gestation; 12 fetuses were hydropic at the time of shunting. In all 17 cases effective chronic drainage of the pleural effusions was achieved. Respiratory status at follow-up was assessed by documentation of respiratory symptoms and measurement of functional residual capacity (FRC) by a helium gas dilution technique. Six infants suffered from recurrent respiratory symptoms, this incidence (37%) did not differ significantly from that found in a control group. The mean FRC of the study population was 28 ml/kg (range 19-34 ml/kg), only 2 infants' FRCs were below the reference range. These results suggest that pleuro-amniotic shunting may, be effective drainage of pleural effusion and hence prevention of chronic antenatal intrathoracic compression, avoid impairment of antenatal lung growth.