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Neonatal management and outcome after thoracoamniotic shunt placement for fetal hydrothorax
  1. Ruben S G M Witlox1,
  2. Frans J C M Klumper2,
  3. Arjan B te Pas1,
  4. Erik W van Zwet3,
  5. Dick Oepkes2,
  6. Enrico Lopriore1
  1. 1Department of Paediatrics, Division of Neonatology, Leiden University Medical Center, Leiden, The Netherlands
  2. 2Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
  3. 3Department of Medical Statistics, Leiden University Medical Center, Leiden, The Netherlands
  1. Correspondence to Dr Ruben S G M Witlox, Division of Neonatology, department of Paediatrics, J6-S, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands; r.witlox{at}lumc.nl

Abstract

Aim To evaluate the short-term neonatal outcome after fetal thoracoamniotic shunt placement for isolated hydrothorax.

Methods Retrospective evaluation of infants with isolated hydrothorax treated with thoracoamniotic shunt placement at our fetal therapy centre between 2001 and 2016.

Results In total 48 fetuses were treated with a thoracoamniotic shunt. All fetuses had signs of hydrops at the time of intervention. Median (IQR) gestational age at shunting was 28.7 (24.4–31.3) weeks. Forty-one of 48 (85%) fetuses were born alive at a median (IQR) gestational age of 34.4 (31.1–36.7) weeks. In one child the course of disease after birth was unknown (this child was excluded from further analyses). After birth, 24/40 (60%) children had signs of pleural effusion and 12/40 (30%) needed a thoracic shunt for continuous pleural drainage. Twenty-one (53%) children required mechanical ventilation, of whom 13 (33%) needed high-frequency ventilation as rescue therapy. Overall 30/40 (75%) infants survived the neonatal period. Neonatal survival rate was significantly higher when infants were born ≥32 weeks’ gestation as compared with <32 weeks: 93% (26/28) versus 33% (4/12), p<0.01.

Conclusion Postnatal course of hydropic fetuses treated with thoracoamniotic shunt for isolated hydrothorax is often complicated by respiratory failure and persistent pleural effusions. Neonatal survival is good provided delivery occurs at or after 32 weeks’ gestation.

  • fetal therapy
  • hydrops fetalis
  • hydrothorax
  • chylothorax
  • thoracoamniotic shunt

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Footnotes

  • Contributors RSGMW, ABtP and EL conceptualised and designed the study, drafted the initial manuscript, carried out the initial analyses, and reviewed and revised the manuscript. RSGMW, FJCMK, ABtP, EWvZ, DO and EL critically reviewed the manuscript. All authors approved the final manuscript as submitted.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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