{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T08:33:58Z","timestamp":1740126838643,"version":"3.37.3"},"reference-count":34,"publisher":"Georg Thieme Verlag KG","issue":"04","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Eur J Pediatr Surg"],"published-print":{"date-parts":[[2024,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Introduction\u2003Despite advances in neonatal intensive care, fetuses with congenital diaphragmatic hernia (CDH) remain to have a poor prognosis. Exclusive postnatal treatment is inadequate in patients with moderate CDH (observed than expected lung-to-head ratio [O\/E LHR] 26\u201345%) and can lead to respiratory failure at birth, requiring extracorporeal membrane oxygenation in 75% of cases. An ex-utero intrapartum treatment (EXIT) procedure may be beneficial in these cases, improving the fetal-neonatal transition.<\/jats:p><jats:p>\n          Material and Methods\u2003We review all pregnancies with fetal isolated left CDH with moderate O\/E LHR delivered by EXIT in our center from January 2007 to December 2022. Maternal and neonatal variables were analyzed. As primary outcomes, we included neonatal survival and mortality rates, surgical and infectious complications, uterine scar dehiscence, and blood loss during EXIT. As secondary outcomes, we studied recurrences of the diaphragmatic defect, long-term evolution, subsequent pregnancies, and mode of delivery.<\/jats:p><jats:p>\n          Results\u2003A total of 14 patients were delivered by the EXIT procedure, with a neonatal survival rate of 85.7%. All these children had optimal physical and neurocognitive development and no pulmonary morbidity. We found no major complications and 7.1% of minor maternal complications. There were no cases of surgical wound infection or endometritis. The median decrease in hemoglobin during the EXIT procedure was 1.9\u2009mg\/dL, and only one case required postoperative transfusion. Two out of the 14 women became pregnant again, and both pregnancies were uneventful.<\/jats:p><jats:p>\n          Conclusions\u2003In our series, the EXIT procedure allows for adequate airway management associated with a high neonatal survival rate in patients with moderate O\/E LHR CDH, with a low rate of neonatal and maternal complications.<\/jats:p>","DOI":"10.1055\/a-2133-8380","type":"journal-article","created":{"date-parts":[[2023,7,20]],"date-time":"2023-07-20T22:57:06Z","timestamp":1689893826000},"page":"319-324","source":"Crossref","is-referenced-by-count":2,"title":["Maternal and Neonatal Outcomes After Ex-Utero Intrapartum Treatment for Congenital Diaphragmatic Hernia: A Case Series"],"prefix":"10.1055","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4839-2034","authenticated-orcid":false,"given":"Angel","family":"Chimenea","sequence":"first","affiliation":[{"name":"Department of Materno-Fetal Medicine, Genetics, and Reproduction, Institute of Biomedicine of Seville (IBIS), Hospital Universitario Virgen del Rocio\/CSIC\/University of Seville, Seville, Spain"},{"name":"Fetal, IVF, and Reproduction Simulation Training Centre (FIRST), Seville, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8010-9628","authenticated-orcid":false,"given":"Marta","family":"Dom\u00ednguez-Moreno","sequence":"first","affiliation":[{"name":"Department of Materno-Fetal Medicine, Genetics, and Reproduction, Institute of Biomedicine of Seville (IBIS), Hospital Universitario Virgen del Rocio\/CSIC\/University of Seville, Seville, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mar\u00eda","family":"Barrera-Talavera","sequence":"additional","affiliation":[{"name":"Department of Materno-Fetal Medicine, Genetics, and Reproduction, Institute of Biomedicine of Seville (IBIS), Hospital Universitario Virgen del Rocio\/CSIC\/University of Seville, Seville, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5040-4896","authenticated-orcid":false,"given":"Lutgardo","family":"Garc\u00eda-D\u00edaz","sequence":"additional","affiliation":[{"name":"Department of Materno-Fetal Medicine, Genetics, and Reproduction, Institute of Biomedicine of Seville (IBIS), Hospital Universitario Virgen del Rocio\/CSIC\/University of Seville, Seville, Spain"},{"name":"Department of Surgery, University of Seville, Seville, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2113-074X","authenticated-orcid":false,"given":"Guillermo","family":"Anti\u00f1olo","sequence":"additional","affiliation":[{"name":"Department of Materno-Fetal Medicine, Genetics, and Reproduction, Institute of Biomedicine of Seville (IBIS), Hospital Universitario Virgen del Rocio\/CSIC\/University of Seville, Seville, Spain"},{"name":"Fetal, IVF, and Reproduction Simulation Training Centre (FIRST), Seville, Spain"},{"name":"Department of Surgery, University of Seville, Seville, Spain"},{"name":"Centre for Biomedical Network Research on Rare Diseases (CIBERER), Seville, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2023,9,8]]},"reference":[{"issue":"03","key":"ref1","doi-asserted-by":"crossref","first-page":"659","DOI":"10.1016\/j.suc.2012.03.003","article-title":"Congenital diaphragmatic hernia and protective ventilation strategies in pediatric surgery","volume":"92","author":"A Garcia","year":"2012","journal-title":"Surg Clin North Am"},{"issue":"01","key":"ref2","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1016\/j.siny.2009.07.012","article-title":"Management of prenatally diagnosed congenital diaphragmatic hernia","volume":"15","author":"H L Hedrick","year":"2010","journal-title":"Semin Fetal Neonatal 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