Neurodevelopmental outcomes in children with isolated congenital diaphragmatic hernia: A systematic review and meta-analysis

Background: Congenital diaphragmatic hernia (CDH) reportedly has neurologic consequences in childhood however little is known about the impact in isolated CDH. / Aims: Herein we aimed to describe the risk of neurodevelopmental complications in children born with isolated CDH. / Materials & Methods: We systematically reviewed literature for reports on the neurological outcome of infants born with isolated CDH. The primary outcome was neurodevelopmental delay. Secondary outcomes included, motor skills, intelligence, vision, hearing, language and behavior abnormalities. / Results: Thirteen out of 87 (15%) studies reported on isolated CDH, including 2624 out of 24,146 children. Neurodevelopmental delay was investigated in four studies and found to be present in 16% (3‐34%) of children. This was mainly attributed to motor problems in 13% (2‐30%), whereas cognitive dysfunction only in 5% (0‐20%) and hearing in 3% (1‐7%). One study assessed the effect of fetal surgery. When both isolated and non‐isolated children were included, these numbers were higher. / Discussion: This systematic review demonstrates that only a minority of studies focused on isolated CDH, with neurodevelopmental delay present in 16% of children born with CDH. / Conclusion: To accurately counsel patients, more research should focus on isolated CDH cases and examine children that underwent fetal surgery

Dimensionless Squared Jerk - An Objective Differential to Assess Experienced and Novice Probe Movement in Obstetric Ultrasound

Objective: Widely accepted, validated and objective measures of ultrasound competency have not been established for clinical practice. Outcomes of training curricula are often based on arbitrary thresholds, such as the number of clinical cases completed. We aimed to define metrics against which competency could be measured. Method: We undertook a prospective, observational study of obstetric sonographers at a UK University Teaching Hospital. Participants were either experienced in fetal ultrasound (n = 10, >200 ultrasound examinations) or novice operators (n = 10, <25 ultrasound examinations). We recorded probe motion data during the performance of biometry on a commercially available mid‐trimester phantom. Results: We report that Dimensionless squared jerk, an assessment of deliberate hand movements, independent of movement duration, extent, spurious peaks and dimension differed significantly different between groups, 19.26 (SD 3.02) for experienced and 22.08 (SD 1.05, p = 0.01) for novice operators, respectively. Experienced operator performance, was associated with a shorter time to task completion of 176.46 s (SD 47.31) compared to 666.94 s (SD 490.36, p = 0.0004) for novice operators. Probe travel was also shorter for experienced operators 521.23 mm (SD 27.41) versus 2234.82 mm (SD 188.50, p = 0.007) when compared to novice operators. Conclusion: Our results represent progress toward an objective assessment of technical skill in obstetric ultrasound. Repeating this methodology in a clinical environment may develop insight into the generalisability of these findings into ultrasound education

Cranial findings detected by second-trimester ultrasound in fetuses with myelomeningocele:a systematic review

BACKGROUND: Abnormal intracranial findings are often detected at mid-trimester ultrasound (US) in fetuses with MMC. It is unclear whether these findings constitute a spectrum of the disease or are an independent finding, which should contraindicate fetal surgery. OBJECTIVE: To ascertain the spectrum and frequency of US detected cranial findings in MMC fetuses. SEARCH STRATEGY: MEDLINE, Embase, Web of Science and CENTRAL search, January 2000-June 2020. SELECTION CRITERIA: Study reporting incidence of cranial US findings in consecutive cases of second trimester MMC fetuses. DATA COLLECTION AND ANALYSIS: Publication quality was assessed by NOS and modified NOS. Meta-analysis could not be performed due to high clinical diversity and study heterogeneity. RESULTS: 14 cranial US findings were reported in 15 studies. Findings in classic Chiari II malformation (CIIM) spectrum included posterior fossa funnelling (96%), small transcerebellar diameter (82-96%), 'banana' sign (50-100%), beaked tectum (65%) and 'lemon' sign (53-100%). Additional cranial findings were small BPD and HC (<5th centile; 53% and 71%, respectively), ventriculomegaly (45-89%), abnormal pointed-shape of the occipital horn (77-78%), thinning of the posterior cerebrum, perinodular heterotopia (11%), abnormal gyration (3%), corpus callosum disorders (60%) and midline interhemispheric cyst (42%). CONCLUSIONS: We identified 14 cranial findings by second trimester US in MMC fetuses. The relatively high incidence of these findings and their unclear prognostic significance might not contraindicate fetal surgery in the case of normal fetal genetic testing. Some cranial findings however may independently impact postnatal outcome. Long-term detailed follow up is required to investigate this

Patient empowerment improves follow‐up data collection after fetal surgery for spina bifida: institutional audit

Objectives To define and grade fetal and maternal adverse events following fetal surgery for spina bifida and to report on the impact of engaging patients in collecting follow-up data. Methods This prospective single-center audit included one hundred consecutive patients undergoing fetal surgery for spina bifida from the first onwards. In our setting, patients return to their referring unit for further pregnancy care and delivery. On discharge, referring hospitals were requested to return outcome data. For this audit, we prompted patients and referring hospitals for missing outcomes. Outcomes were categorized as missing, returned spontaneously or following additional request, and as either provided by the patients or referring center. Postoperative maternal and fetal complications until delivery were defined and graded according to the Maternal and Fetal Adverse Event Terminology (MFAET) and the Clavien-Dindo classification. Results There were no maternal deaths and seven (7%) severe maternal complications (anemia in pregnancy, postpartum hemorrhage, pulmonary edema, lung atelectasis, urinary tract obstruction, and placental abruption). No uterine ruptures were reported. Perinatal death occurred in 3% and other severe fetal complications in 15% (perioperative fetal bradycardia/cardiac dysfunction, fistula-related oligohydramnios, and preterm rupture of membranes <32 weeks). Preterm rupture of membranes occurred in 42% and overall, delivery took place at a median gestational age of 35.3 weeks [IQR 34.0-36.6]. Information following additional request, both from centers, but mainly through patients reduced missing data by 21% for the gestational age at delivery, by 56% for the uterine scar status at birth, and by 67% for the shunt insertion at 12 months. Compared to the generic Clavien-Dindo classification, the Maternal and Fetal Adverse Event Terminology ranked complications in a clinically more relevant way. Conclusions The nature and rate of severe complications were similar to those reported in other larger series. Spontaneous return of outcome data by referring centers was low, yet patient empowerment improved data collection

Patient empowerment improves follow-up data collection after fetal surgery for spina bifida: institutional audit

OBJECTIVES: To define and grade fetal and maternal adverse events following fetal surgery for spina bifida and to report on the impact of engaging patients in collecting follow-up data. METHODS: This prospective single-center audit included one hundred consecutive patients undergoing fetal surgery for spina bifida from the first onwards. In our setting, patients return to their referring unit for further pregnancy care and delivery. On discharge, referring hospitals were requested to return outcome data. For this audit, we prompted patients and referring hospitals for missing outcomes. Outcomes were categorized as missing, returned spontaneously or following additional request, and as either provided by the patients or referring center. Postoperative maternal and fetal complications until delivery were defined and graded according to the Maternal and Fetal Adverse Event Terminology (MFAET) and the Clavien-Dindo classification. RESULTS: There were no maternal deaths and seven (7%) severe maternal complications (anemia in pregnancy, postpartum hemorrhage, pulmonary edema, lung atelectasis, urinary tract obstruction, and placental abruption). No uterine ruptures were reported. Perinatal death occurred in 3% and other severe fetal complications in 15% (perioperative fetal bradycardia/cardiac dysfunction, fistula-related oligohydramnios, and preterm rupture of membranes <32 weeks). Preterm rupture of membranes occurred in 42% and overall, delivery took place at a median gestational age of 35.3 weeks [IQR 34.0-36.6]. Information following additional request, both from centers, but mainly through patients reduced missing data by 21% for the gestational age at delivery, by 56% for the uterine scar status at birth, and by 67% for the shunt insertion at 12 months. Compared to the generic Clavien-Dindo classification, the Maternal and Fetal Adverse Event Terminology ranked complications in a clinically more relevant way. CONCLUSIONS: The nature and rate of severe complications were similar to those reported in other larger series. Spontaneous return of outcome data by referring centers was low, yet patient empowerment improved data collection. This article is protected by copyright. All rights reserved