Publications by authors named "Dekoninck P"

Background: Physiological-based cord clamping (PBCC) in preterm infants is beneficial for cardiovascular transition at birth and may optimize placental transfusion. Whether PBCC can improve clinical outcomes is unknown. The aim of the Aeration, Breathing, Clamping (ABC3) trial was to test whether PBCC results in improved intact survival in very preterm infants.

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  • Infants with congenital diaphragmatic hernia often face serious breathing issues, but a technique called physiologically based cord clamping (PBCC) can help improve blood flow to their lungs when performed before cutting the umbilical cord.
  • In a study involving lambs with surgically induced diaphragmatic hernia, PBCC was tested against immediate cord clamping to see its effects on lung function over an 8-hour period following birth.
  • Results showed that lambs undergoing PBCC had significantly higher pulmonary blood flow and lower pulmonary vascular resistance compared to those with immediate cord clamping, indicating that PBCC is more beneficial for lung health in this condition.
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  • The study aimed to evaluate the outcomes of fetuses who had open fetal spina bifida surgery in Canada, collecting data on treatment needs and various developmental aspects post-surgery.
  • A total of 41 fetuses underwent the procedure from 2017 to 2022, with 24 providing follow-up data at a median age of 46.5 months; results revealed mixed outcomes including a significant need for bladder management and varied motor skills.
  • The findings highlighted that while many children displayed typical communication and problem-solving abilities, a majority faced delays in gross motor development, reflecting similar results to previous studies like the MOMs trial.
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Objective: To evaluate the diagnostic yield of exome sequencing (ES) in fetuses and neonates with prenatally detected congenital diaphragmatic hernia (CDH) and normal copy number variant (CNV) analysis.

Methods: We conducted a retrospective cohort study of prenatally diagnosed CDH cases seen between 2019 and 2022. All cases who underwent prenatal or postnatal genetic testing were reviewed.

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Background: Infants born with congenital diaphragmatic hernia (CDH) are at high risk of respiratory insufficiency and pulmonary hypertension. Routine practice includes immediate clamping of the umbilical cord and endotracheal intubation. Experimental animal studies suggest that clamping the umbilical cord guided by physiological changes and after the lungs have been aerated, named physiological-based cord clamping (PBCC), could enhance the fetal-to-neonatal transition in CDH.

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  • The ABC3 trial investigates the potential benefits of physiological-based cord clamping (PBCC) compared to standard time-based cord clamping (TBCC) for very preterm infants, aiming to reduce complications like cerebral injury and necrotizing enterocolitis (NEC).
  • It is a multicenter, randomized clinical trial involving infants born before 30 weeks of gestation, assessing outcomes such as intact survival and short-term co-morbidities during NICU admission.
  • The results of this study will inform future clinical guidelines regarding optimal cord clamping practices at birth to enhance infant health outcomes.
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Introduction: Infants with congenital diaphragmatic hernia (CDH) often develop pulmonary hypertension but frequently fail to respond to vasodilator therapy, for instance because of an altered pulmonary vasoreactivity. Investigating such alterations in vivo is impossible. We hypothesised that these alterations are also present in fetoplacental vessels, since both vasculatures are exposed to the same circulating factors (e.

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Background: Infants with a congenital diaphragmatic hernia (DH) have underdeveloped lungs and require mechanical ventilation after birth, but the optimal approach is unknown. We hypothesised that sustained inflation (SI) increases lung aeration in newborn kittens with a DH.

Methods: In pregnant New Zealand white rabbits, a left-sided DH was induced in two fetal kittens per doe at 24-days gestation (term = 32 days); litter mates acted as controls.

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Pathophysiological studies have shown that pulmonary vascular development is impaired in fetuses with a congenital diaphragmatic hernia (CDH), leading to a simplified vascular tree and increased vascular resistance. Multiple studies have described prenatal ultrasound parameters for the assessment of the pulmonary vasculature, but none of these parameters are used in daily clinical practice. We provide a comprehensive review of the literature published between January 1990 and February 2022 describing these parameters, and aim to explain the clinical relevance of these parameters from what is known from pathophysiological studies.

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Introduction: We performed a systematic review and meta-analysis on the incidence of secondary tethered spinal cord (TSC) between prenatal and postnatal closure in patients with MMC. The objectives was to understand the incidence of secondary TSC after prenatal surgery for MMC compared to postnatal surgery for MMC.

Material And Methods: On May 4, 2023, a systematic search was conducted in Medline, Embase, and the Cochrane Library to gather relevant data.

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Introduction: Infants with congenital diaphragmatic hernia (CDH) are commonly intubated immediately after birth. Consensus on whether to provide sedation prior to intubation in the delivery room is lacking, although avoidance of stress is especially important in this population with high risk of pulmonary hypertension. We aimed at obtaining an overview of local pharmacological interventions and at providing guidance on delivery room management.

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Objectives: To describe the outcomes of preterm born infants with congenital diaphragmatic hernia (CDH; ≤32.0 weeks of gestation) and the associations between prenatal imaging markers and survival.

Design: Retrospective cohort study.

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Congenital diaphragmatic hernia (CDH) is a major cause of severe lung hypoplasia and pulmonary hypertension in the newborn. While the pulmonary hypertension is thought to result from abnormal vascular development and arterial vasoreactivity, the anatomical changes in vascular development are unclear. We have examined the 3D structure of the pulmonary arterial tree in rabbits with a surgically induced diaphragmatic hernia (DH).

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Objective: To develop a realistic simulation model for laparotomy-assisted fetoscopic spina bifida aperta (SBa) surgery, to be used for training purposes and preoperative planning.

Methods: The predefined general requirement was a realistic model of an exteriorized uterus, allowing all neurosurgical steps of the intervention. The uterus was modelled using ultrasound and MRI images of a 25 weeks' gravid uterus, consisting of flexible polyurethane foam coated with pigmented silicone.

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Objective: To evaluate the incidence of termination of pregnancies (TOP) and factors associated with the decision for TOP in prenatally detected congenital diaphragmatic hernia (CDH).

Study Design: Single-centre retrospective cohort includes all prenatally detected CDH cases born between January 2009 and December 2021. Parental factors, such as parity, and fetal characteristics, such as disease severity, were collected.

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  • The study aimed to assess the oxygen saturation index (OSI) as an early indicator of clinical deterioration in infants with congenital diaphragmatic hernia (CDH).
  • Researchers conducted a cohort study of infants with isolated CDH and analyzed continuous OSI measurements taken within the first 24 hours after birth to predict outcomes like pulmonary hypertension, ECMO therapy, and mortality.
  • The findings showed that maximum and mean OSI values significantly correlate with clinical complications, allowing for early identification of high-risk infants, which can help customize their postnatal care.
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Objective: Ten years ago, the authors reported on the outcome of their study investigating the degree of discomfort and pain in newborns with myelomeningocele (MMC), using the parameters of unbearable and hopeless suffering. In the current study, they investigated the quality of life, daily functioning, pain and fatigue, ability to communicate, and number of surgeries in the same cohort of patients. They subdivided their study population into severe (Lorber) and less severe (non-Lorber) cases and compared these cases with a healthy population (non-MMC group) and with each other.

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Background: International guidelines recommend delayed umbilical cord clamping (DCC) up to 1 min in preterm infants, unless the condition of the infant requires immediate resuscitation. However, clamping the cord prior to lung aeration may severely limit circulatory adaptation resulting in a reduction in cardiac output and hypoxia. Delaying cord clamping until lung aeration and ventilation have been established (physiological-based cord clamping, PBCC) allows for an adequately established pulmonary circulation and results in a more stable circulatory transition.

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  • Infants with mild congenital diaphragmatic hernia (CDH) have a high survival rate (90%), and personalized resuscitation methods—such as supporting spontaneous breathing—may improve outcomes compared to standard mechanical ventilation.
  • A resuscitation algorithm was created by discussing initial ideas with local stakeholders and refining them with international expert input to provide a structured approach for managing these infants effectively.
  • The proposed algorithm targets infants with certain criteria, encouraging non-invasive respiratory support during the transition from fetal to neonatal care, showcasing the potential benefits of individualized strategies in CDH management.
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Introduction: Pulmonary hypertension is a major determinant of postnatal survival in infants with a congenital diaphragmatic hernia (CDH). The current care during the perinatal stabilisation period in these infants might contribute to the development of pulmonary hypertension after birth-in particular umbilical cord clamping before lung aeration. An ovine model of diaphragmatic hernia demonstrated that cord clamping after lung aeration, called physiological-based cord clamping (PBCC), avoided the initial high pressures in the lung vasculature while maintaining adequate blood flow, thereby avoiding vascular remodelling and aggravation of pulmonary hypertension.

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Objective: Monochorionic diamniotic twin pregnancies complicated by Type-III selective fetal growth restriction (sFGR) are at high risk of fetal death. The aim of this study was to identify predictors of fetal death in these pregnancies.

Methods: This was an international multicenter retrospective cohort study.

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  • Recent clinical research on congenital diaphragmatic hernia (CDH) infants has shifted focus to the critical perinatal transition period, where significant respiratory complications can arise.
  • New evidence suggests that management strategies during this early stabilization phase in the delivery room may impact long-term health outcomes for these infants.
  • Innovative approaches, such as resuscitating infants with an intact umbilical cord, are being studied, alongside monitoring key physiological parameters in the first 24 hours of life for early detection of potential issues.
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Introduction: The oxygenation index (OI) is a marker for respiratory disease severity and adverse neonatal outcomes. The oxygen saturation index (OSI) is an alternative that allows for continuous noninvasive monitoring, but evidence for clinical use in critically ill neonates is scarce. The aim of this study was to evaluate the OSI as compared to the OI in term neonates with a congenital diaphragmatic hernia (CDH).

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Background: Two randomized controlled trials compared the neonatal and infant outcomes after fetoscopic endoluminal tracheal occlusion with expectant prenatal management in fetuses with severe and moderate isolated congenital diaphragmatic hernia, respectively. Fetoscopic endoluminal tracheal occlusion was carried out at 27 to 29 weeks' gestation (referred to as "early") for severe and at 30 to 31 weeks ("late") for moderate hypoplasia. The reported absolute increase in the survival to discharge was 13% (95% confidence interval, -1 to 28; P=.

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