Difficulties in the hemodynamic assessment of the newborn with prenatally treated congenital diaphragmatic hernia.

Congenital diaphragmatic hernia (CDH) is a malformation with a diverse clinical picture. Its severity can be assessed prenatally using the lung area to head circumference ratio (LHR). LHR lower than 1 as associated with high mortality is an indication for prenatal treatment involving occlusion of fetal trachea. Before such treatment other congenital malformations must be excluded. Assessment of circulatory system in these patients is difficult. Heart is compressed by viscera in the thorax that decreases blood return to the left atrium, and structures of the left heart may be smaller than in healthy fetuses. The echocardiographic picture may be similar to some congenital defects of the left heart. Differentiation between structural and functional cardiac abnormalities is difficult but essential for diagnostic and therapeutic decisions in the most severe type of CDH. The authors present problems with interpretation of hemodynamic disturbances in a neonate with prenatally diagnosed and treated severe CDH.

[Cranial ultrasound through posterolateral fontanelle in visualization of posterior fossa abnormalities in preterm and term neonates]. / Ultrasonografia glowy przez ciemiaczko tylno- boczne w ocenie nieprawidlowosci tylnego dolu czaszki u wczesniaków i noworodk>w donoszonych.

OBJECTIVES: The aim of the study was to evaluate the usefulness of US in the diagnosis of posterior fossa abnormalities in neonates by posterolateral fontanelle as compared with the anterior fontanelle approach and MRI. MATERIAL AND METHODS: US studies were performed on 1337 neonates, including 512 preterm infants, through the anterior and posterolateral fontanelles. Abnormalities were detected in 134 patients. Among them, abnormalities in posterior fossa were visualized with the posterolateral approach in 14 neonates. MR images were obtained in that subgrqup. RESULTS: The lesions consisted of cerebellar hemorrhage and congenital cerebellar malformations. Foci of hemorrhage were visualized by US in preterm neonates (n = 5), only through the posterolateral approach and on MRI. Dandy-Walker malformations (n = 2) were detected by US with both approaches and confirmed on MRI. In pontocerebellar hypoplasia (n =2), US with both approaches, showed hypoplastic cerebellar hemispheres and fluid in the posterior fossa. MRI, additionally visualized pontine hypoplasia. Fluid collection in the posterior fossa and translocation of cerebellar hemispheres were observed in the other 6 neonates by US with both approaches. MRI revealed arachnoid cysts (n = 2), mega cisterna magna (n = 3) and Blake's pouch (n = 1). CONCLUSIONS: US using posterolateral fontanelle is the method of choice for the diagnosis of cerebellar hemorrhage. These lesions are not visualized through anterior fontanelle. US visualization of the abnormal structures in some cerebellar malformations has similar effectiveness for both approaches. MRI plays the crucial role in identification and differential diagnosis of these malformations.

[Maternal hyperoxygenation test in prediction of fetal lung hypoplasia--preliminary report]. / Przydatnosc testu hiperoksygenacji w prognozowaniu hipoplazji pluc u plodów--donlesienie wstepne.

OBJECTIVES: The aim of our study was to present the detailed execution and interpretation of the hyperoxygenation test in the fetus. MATERIAL AND METHODS: This was a retrospective investigation of fetuses examined in The Department for Diagnosis and Prophylaxis of Congenital Malformations (Polish Mothers Memorial Hospital Institute and Medical University in Lodz) between January 2006 and December 2009, in whom in addition to the routine echocardiographic examination the hyperoxygenation test was performed. Indications for such an extended evaluation were suspected fetal malformations and pulmonary hypoplasia. Changes in the fetal pulmonary circulation before and after maternal exposure to hyperoxygenated air together with the newborn follow-up were analyzed. RESULTS: Clinical outcome was available for 42 of 52 cases: 16 patients died (including 11 cases with negative hyperoxygenation test), whereas 24 patients were discharged home (including 17 cases with positive hyperoxygenation test). The probability of survival for fetuses with the positive test was significantly higher than for fetuses with the negative one (p = 0.016, Fischer's exact test). CONCLUSIONS: Based on changes evoked in the fetal pulmonary circulation, the hyperoxygenation test seems helpful in predicting impaired fetal lung development Functional assessment of the fetal pulmonary circulation may be useful in predicting fetal lung hypoplasia and respiratory failure in the neonate.