Congenital primary hydrothorax: effect of thoracoamniotic shunting on neonatal clinical outcome

Abstract

Background. Spontaneous regression in the foetal period has been described for congenital hydrothorax. Hydrothorax may become larger and bilateral with hydrops and pulmonary hypoplasia. Prenatal thoracentesis and thoracoamniotic shunting of massive hydrothorax are indicated to decrease perinatal morbidity. In the neonatal period, persistent hydrothorax may require intensive care.

Objective. To investigate neonatal outcome after thoracoamniotic shunting for congenital primary hydrothorax with hydrops/ polydramnios.

Methods. Retrospective study on the postnatal management of a cohort of 28 congenital primary hydrothorax cases after thoracoamniotic shunting (January 2000–August 2005).

Results. Congenital hydrotorax without major structural anomalies complicated by polidramnios and/or hydrops <34 weeks' gestation were the criteria accepted for thoracoamniotic shunting. There were neither pregnancy terminations nor utero deaths. Although 64% of cases were complicated by severe neonatal respiratory insufficiency, neonatal mortality rate was low (21.4%) if compared with literature. Univariate analysis identified ‘birth at gestational age (GA) <35 weeks’ and ‘time between prenatal shunting and birth’ as predictive factors for needing of ventilation. Multivariate analysis identified ‘birth at GA <35 weeks’ as the only independent predictor for needing ventilation. (OR = 0.08, CI 95% = 0.01–0.96, p = 0.046). No risk factors for death or adverse neurological outcomes were reported.

Conclusions. Congenital hydrothorax although corrected by thoracoamniotic shunting is complicated by severe respiratory distress. The neonatal outcome may be improved limiting degree of prematurity; the presence of thoracoamniotic shunt is not per se an indication of premature birth, at least until GA >35 weeks and adequate pulmonary maturity is reached.

Keywords:

• Newborn
• hydrothorax
• thoracoamniotic shunting
• postnatal management

Acknowledgements

The authors are indebted to their NICU and Staff members who participated in the study. The authors thank and remember Prof. Umberto Nicolini who contributed to the prenatal data but prematurely left this world and his friends.